HomeMy WebLinkAboutHicksBarbara Affidavit Disclosure 2009 X+U { J (-
From the 1126I09 Council Meeting Packet CITY OF LANSING
REFERRED TO THE BOARD OF
AFFIDAVIT OF DISCLOSURE
ETHICS
DATE:
TO: CITY CLERK,
CITY ATTORNEY, or
BOARD OF ETHICS
9- -,/GS make the following disclosure under oath:
(Name)
PLEASE CHECK THE APPROPRIATE BOX OR FILL IN THE BLANKS FOR EACH OF THE
FOLLOWING ITEMS
Yes No
1. ram ❑ I am an ❑ elected or ❑ appointed ❑ officer or Ej/employee of the City of
L7/T,
sing holding the positio�of 6x�� /`i ye iti�T in the
r�'.�/�r�1 .�7oDIJ /mil department
E1,Z ❑ I am an immediate family member related to anAedor appoi ed
officer or employee of e,City of Lansing namedholding the position of� , in
department.
❑ Er"" I am a Business Associate of an elected or appointed officer or employee
of the City of Lansing named
Holding the position of in the
Department.
2. ❑ o� 1 may derive income or benefit directly from a contract with the City or
from any City action detailed below. (Charter 5-505.1)
❑ 1 may have a conflict between a personal interest and the public interest,
the nature of which is disclosed below (Charter 5-505.2) [Chapter
#290.04(I) of-the Code of Ordinances]
❑ 1 may have a financial interest in a matter proposed to be acted upon by
the City of Lansing as described below [Chapter 290.04(I) of the Code of
/ Ordinances]
�Y ❑ 1 make this disclosure because of a possible appearance that I may be
in violation of or in conflict with the City of Lansing Ethics Ordinance as
provided for in the Code or Ordinances and in the City Charter
3. This position is: ❑ Full time ❑'Part time (less than 25 hours/wk) ❑ Unpaid
4. My Address is:/ _4�Zj
CONTINUED ON PAGE 2
AFFIDAVIT OF DISCLOSURE-PAGE 2
5. My Business (daytime) Phone # is: 17�1 l// �� �y
PLEASE DESCRIBE IN DETAIL YOUR REASON(S) FOR SUBMITTING THIS DISCLOSURE
6 AND EXPLAIN WHY YOU THINK A CONFLICT MAY/MAY NOT EXIST.
I hereby certify that this disclosure is complete and accurate to the best of my
knowledge, information and belief.
The foregoing Affidavit of Disclosure was execrated can this /6 _dav of
�L
Signed
State of Michigan, County of
Subscribed and sworn to before iIi7e this /L '` day of 20 2 y
M S.REEWS Notary Public%r Deputy Clerk
NOTARy PUBLIC-STATE OFM►CI.IIGA i COUNTY OF INGHAM �� � County, Michigan
+
MYCammfsslon Expires IVov.18,2013
AGIng In the C;aunly of Ingham
/w✓ My Commission Expires: / I - i,y - �? v I y
DRAFT 5A;REVISED 1M9-01