HomeMy WebLinkAboutJawrenceMark Affidavit Disclosure 2018 �,L-1 S
CITY OF LANSM6
AFFIDAVIT OF DISCLOSURE- ,
CHIG
TO: CITY CLERK, DATE:
CITY ATTORNEY or
BOARD OF ETHICS
I Mark 1_4LV re,n C�e make the following disclosure under oath:
(Name)
PLEASE CHECK THE BOX AND FILL IN THE APPROPRIATE BLANKS FOR EACH OF THE
FOLLOWING ITEMS
Yes/ No
1. C7 ❑ I am an ❑elected or appointed ❑ officer or 2e"mployee of the City of
Lansing holding the position of e_i+izc+A Ajugui
in the Mager 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
❑ E ' 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 or indirectly from the bidding of,
negotiation of, solicitation of or entry into a contract with the City or from
and 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]
❑ C1 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]
❑ 0 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 of Ordinances and in the City Charter,
3. MY-City of Lansing position is:
T Full-time ❑ Part-time (less than 25 hours/wk) ❑ Unpaid
4 PLEASE DESCRIBE IN DETAIL AND EXPLAIN WHY YOU YOUR REASON(S)FOR SUBMITTING THIS DISCLOSURE
THINKA CONFLICT MAY/MAYNOT EXIST;
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Glad
C 2rd n
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hereby certify that this disclosure is complete and accurate to the best of my knowled
information and belief. ge,
The foregoing Affidavit of Disclosure was executed on this �t
20 1S day of_ M
a�
igned
State of Michigan, County ofA.�
Subscribed and sworn to before me this -AC day
20 /4
NO'PAM PUBLIC-STATE OF WCHICM
Notary Public/or Deputy Clerk
M�YCWA*slooEvk�ee�idWGMbWY.2018 County Michigan
My Commission Expires: . ], J ��
ATTACHMENT TO AFFIDAVIT OF DISCLOSURE
Please provide additional information about your outside business or employment. Of special
interest to the Board is how the activities of the business or employment may directly or
indirectly affect the City. This disclosure is about information and is not an indication of any
anticipated conflict of interest or suspected wrongdoing. Therefore, please describe for the Board
what it is you actually do and be detailed and specific. You are not required to limit your
disclosure only to the following questions. For each business, include in your answer such things
as: (�
■ What is the form of your business entity and what percentage do you own?
c;w $
(5 % '
■ Are you self-employed? N C)
■ Who is your employer, if applicable? Ct tt/ ct 4, '-f m y
■ What are the things you actually do in the business?
■ Who are your clients and who receives your goods or services?
■ How and where are your services performed? W-4
■ How often do you do outside work? I y LA-
• Does your business or employer contract with the City?
■ In performing your business or outside employment, do you use any City facilities or equipment?
UJ If so, describe:
■ Is any of your bus ness or employment conducted in the City? If so, describe:
■ Does your business advertisement or circulars, if any, contain any reference to the City or your
City employment?
■ 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? If so,please
describe: I WUt d'h S �bc�• �y �G
It s� WyvlG !� c I �l 1n Cavc'st
1'� �b� rt��rn's�l��t�l NA�d�rw4 (.1 LEI��S►7`l��_
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.