HomeMy WebLinkAboutJacksonBrian Affidavit Disclosure 2021 y�N Si
CITY OF LANSING
AFFIDAVIT OF DISCLOSURE
CHIGP
TO: CITY CLERK DATE: 1-5-2021
1, Brian Patrick Jackson make the following disclosure under oath:
Name (please print)
PLEASE CHECK THE BOX AND FILL IN THE APPROPRIATE BLANKS FOR EACH OF THE FOLLOWING
ITEMS
Yes No
1. V ❑ 1 am an ❑ elected or ❑ appointed ❑ officer or employee of the Cit of Lansin
holding the position of Chief Deputy City Clerk y g
in the Clerk's office 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
❑ ❑ 1 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. ❑ A:licitation
1 may derive income or benefit directly or indirectly from the bidding of,
negotiation of or entry into 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", scribed below. [Chapter 290.04(I) of the Code of Ordinances]
❑ 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
of Ordinances and in the City Charter.
3. My City of Lansing position is:
e Full-time ❑ Part-time (less than 25 hours/wk) ❑ Unpaid
4. Name of the activity/business in question: spouse is on the Northwest Initiatives(Nwl)Board of Directors
5. Do you have ownership or interest in the activity/business? Yes Nox
Updated July 2019
6. Does this activity/business conduct business with the City of Lansing? Yesx No
If yes, please explain NWI accepts City general fund grants through the HRCS Department
7. Does the activity/business depend on you being an employee of the City of Lansing?
Yes Nox
If yes, please explain: My wife is on the NWI board, not me.
8. Who are the clients/customers of the activity/business?
NWI is a non-profit working to strengthen communities in Lansing area bounded by the Grand River on the north,east,and south
9. Does this activity/business require your using equipment/facilities of the City of Lansing?
Yes Nox
If yes, please explain:
10. Does the activity/business use any advertisements or circulars that reference your employment
with the City of Lansing? Yes No x
If yes, please attach copies.
11. Explain what you will be doing in the activity/business:
Ocassionally,I will drop off voter registration forms at Northwest Initiative office.No different than for any other organization or individual.
Otherwise,I have limited interaction with Northwest Initiative as I would with any other community focus non-profit which serves City residents.
12. Explain why you believe a conflict may/may not exist with this activity/business:
I have no decision making ability regarding the funding of Northwest Initiative.
I nor my spouse receive any financial benefit from her service on the board.
13. Is there any additional information that you believe would assist the Board of Ethics in its
review of your business or personal activities for potential conflicts of interest? Yes Nox
If so, please describe:
In providing this additional information, the Board of Ethics asks that you give special attention to the
Conflicts of Interest section of the Charter found at 5-505.1 — 5-505.3. A copy is enclosed for your
convenience.
Updated July 2019
I hereby certify that this disclo a is complete and accurate to the best of my know edge, information
and belie a foregoi a it of Disclosure was executed on this 6day of 20a
Signature of Filer
STATE OF MICHIGAN )
)ss.
COUNTY OF
r
The foregoing instrument . kno a ed before me this day of v1
11
,Z6� I (year), by _ (Notary Signat e)
W (Print Name)
Notary Public, /I af API County,
Acting in _1 ez1 14 ram( County,
My Commissig i Expires: y-j,2
Updated July 2019
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