HomeMy WebLinkAboutJordanJack Affidavit Disclosure 2001 (2) CITY OF LANSING
AFFIDAVIT OF DISCLOSURE -
" 0. y
TO: CITY CLERK
CITY ATTORNEY
BOARD OF ETHICS
J�C,rC e -o2,0A-0 (Name), being duly sworn, says under
oath:
1. I am an elected or appointed officer or employee of the City of
Lansing, holding the position of C wl4FF 2:4AUT� C'iTy (Title) in the
A-rrb.ea�y
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):
REFERRED TO ETHICS BOARD
Council mtg - Feb. 26, 2001
(Paragraph 2. CONTINUED)
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/havvee�not 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,-,�,3"4 day of
(Name)
STATE OF MICHIGAN)
) SS.
COUNTY OF
Subscribed and sworn to before me this 23,-,( day of
19 LOI in Z County, Michigan.
Notary P li r
-Deputy-C-ierk
County, Michigan
My Commission Expires:
MARY JO POWM
NOTARY PUBLIC IONIA 00,W
WY COMMISSION EYJNRES Mir 21,2004
ACTING IN INGHAM COUNN,td