HomeMy WebLinkAboutGramKelly Affidavit Disclosure 2000 CITY OF LANSING
AFFIDAVIT OF DISCLOSURE -
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TO: CITY CLERK
CITY ATTORNEY
BOARD OF ETHICS
(Name), being duly sworn, says under
oath:
1. 1 am an elected or appointed officer or employee of the City of
Lansing, holding the position of (Title) in the
Department. This position is:
Full Time: Part Time
(Less than 25 hrs. per week)
Unpaid:
2. 1 may derive income or benefit, directly or indirectly, from a contract
with the City or from any City action detailed as follows (Charter 5-505.1):
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(Paragraph 2. CONTINUED)
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3. 1 have a conflict between a personal interest and the public
interest, the nature of which is disclosed below: (Charter 5-505.2; Lansing
Code 290.04 (1)):
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4. 1 have a financial interest in a matter proposed to be acted upon
by the City of Lansing as described below (Lansing Code 290.04(1):
(Paragraph 4. CONTINUED)
5. 1 have of attached page(s) of additional, detail
concerning this disclosure.
6. 1 hereby certify that this disclosure is complete and accurate to
the best of my knowledge, information and belief.
The foregoing Affidavit of Disclosure was executed on the / day of
(Name)
STATE OF MICHIGAN)
) SS. �SF7� C, N�
COUNTY O S i^7
Subs ri ed nd sworn to before me this I LP day of
2zp in County, Michigan.
Notary Public/or
Deputy Clerk
County, Michigan
My Commission Expires:
DEBORAH 60., C;¢d6k EP,
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