HomeMy WebLinkAboutHughettNicholas Affidavit Disclosure 2008 CITY OF LANSING
AFFIDAVIT OF DISCLOSURE
From the 11-24-08 Council Meeting Packet
DATE:
TO: CITY CLERK,
REFERRED TO THE BOARD OF
CITY ATTORNEY, or
BOARD OF ETHICS ETHICS
I/?r�� -�1CJ� L E'�/i� �'t i' L� make the following disclosure ruder oath:
(Name)
i
PLEASE CHECK THE APPROPRIATE BOX OR FILL IN THE BLANKS FOR EACH OF THE
FOLLOWING ITEMS
Yes No
'1 [�, ❑ 1 am an ❑ elected or ❑ appointed. officer or ❑ employee of the City of
Lansing holding the position of ��� r "+� r' in the
I rC_E' department
❑ ❑ I am an immediate family member related to an elected or appointed
officer or employee of the City of Lansing named ,
holding the position of in the
department.
❑ ❑ 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. ❑ ❑ 1 may derive income or benefit directly from a contract with the City or from
any City action detailed below. (Charter 5-505.1)
❑ ❑ I 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]
❑ ❑ I 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]
❑ I 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..orOrdinances and in the City Charter
3. This position-is`❑Full time > ,Part time (less than 25 hours/wk) -F- .Unpaid `
4. /y'Qddress is:
5. My Business (daytime) Phone # is:
r�
CONTINUED ON PAGE 2 I \
i
AFFIDAVIT OF DISCLOSURE-PAGE 2
PLEASE DESCRIBE IN DETAIL YOUR REASON(S) FOR SUBMITTING THIS
6.
DISCLOSURE AND EXPLAIN WHY YOU THINK A CONFLICT MAY/MAY NOT EXIST.
•)-C /L.•� / /'�/1 C l.-�
_ /
I hereby certify that this disclosure is complete and accurate to the best of my knowledge,
information and belief.
iA
The foregoing Affidavit of Disclosure was executed on this / 1 day of
S L�, 2048
Signed
State of Michigan, County of ,��
Subscribed and sworn to before me this day of ��D��6�1 t 20,416F
Notary Public%r Deputy Clerk
County, Michigan
My Commission Expires:
PLEASE INCLUDE AND SUBMIT A COPY OF YOUR CURRENT JOB DESCRIPTION
DRAFT 5A;REVISED 1I-05-04