HomeMy WebLinkAboutKnechtelDonald Affidavit Disclosure 1994 (3) REFERRED TO THE
ETHICS BOARD
CITY OF LANSING
AFFIDAVIT OF DISCLOSURE
OF
CONFLICT OF INTEREST
TO: [ CITY CLERK or
[ ] CITY ATTORNEY and
[ ] MAYOR and , DEPARTMENT HEAD or
[ ] CITY COUNCIL PRESIDENT
(Name) ,y.�LJ T -�5.� ��/� / being duly sworn,
says under oath:
1. I am an elected or appointed officer or.--employee" cf the
City of Lansing, holding the position of (Title) 4
in the
Department. This position is: [+"Fulltime [ ] Parttime ( less than
25 hours/wk) [ ] Unpaid.
2. [PKI , [ ] and/or my (Relationship)
a member of my immediiate family as defined in Ordinance 290 . 02 ( i ) ,
[ ] and/or (Name ) �!,- cc, �-�JC s �,Pi�r��- ,
a business with which I am associated as defined in Ordinance
290 . 02 ( b) , ( c ) and (d) :
(Select the option or options that apply)
[ ] a. may receive a financial benefit of more than a de
minimus. nature which is distinguishable from the benefits to the
person as a member of the public or as a member of a broad segment
of the public from a decision I would otherwise make or participate
in as an officer or employee. The decision involved is described
as follows :
The financial benefit will be received by the following persons in
the following amounts:
;and/or
[ b. intend to have business dealings with the City of
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Lansing, either directly or indirectly. The business dealings are
specifically described in detail as follows ( include names of each
party, the duration of the dealings, the financial consideration
between the parties, the governmental facilities or services
involved, the nature and degree of assignment of government
employees for fulfillment of dealings, and the nature of any
pecuniary interest)
;and/or
[ ] C. may derive income or benefits , either directly or
indirectly, in addition to official remuneration, as a result of
Council action. The action involved is described as follows:
The income or benefits , in addition to official remuneration, that
will be derived, either directly or indirectly, is described as
follows :
;and/or
[ ] d. may derive income or benefits, either directly or
indirectly, in addition to official remuneration, as a result of
a contract with the City. The contract is specifically described
in detail as follows ( include names of each party, the duration of
the dealings , the financial consideration between the parties , the
governmental facilities or services involved, the nature and degree
of assignment of government employees for fulfillment of the
contract, and the nature of any pecuniary interest ) :
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;and/or
[ ] e. have a conflict between a personal interest and the
public interest as defined by state law, the Lansing City Charter,
or ordinance. The personal interest that conflicts with the public
interest is described as follows :
The public interest that the personal interest conflicts with is
described as follows :
3. I have attached additional detail on the reverse of this
form or on attached sheets, including copies of all relevant
documents, memos , resolutions , and contracts.
4. (Select One) [PK I will not make or participate in the .
making of the affected decision and/or governmental decisions
concerning the contract and/or governmental decisions concerning
the business dealings and/or governmental decisions concerning the
conflict, OR
[ ] Despite the conflict of interest, I am able to make or
participate in the making of the affected decision and/or
governmental decisions concerning the contract and/or governmental
decisions concerning the business dealings and/or governmental
decisions concerning the conflict, fairly, objectively, and in the
public interest because:
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5. I hereby certify that this disclosure is complete and
accurate to the best of my knowledge, information and belief.
6. I hereby. certify that I have not solicited or entered
into any agreement with the City of Lansing prior to filing this
affidavit.
The foregoing Affidavit of Di losure of Conflict of Interest
was executed on the day of X - 19
199CSubscribed nd sworn before me the day of
in County, Michi n
otary Public/or
Deputy Clerk
Notinry Public, Eaton County, Nu County, Michigan
Acting lMing iQ®ltmtit7E Ss i<?unIyE-Mpires
My COMM. (Expires F6. 20, 1995
FOR CITY CLERK/CITY ATTORNEY USAGE
DATE FILED:
COPIES SENT TO: [ ] Mayor
[ ] City Council President
[ ) Department Head
[ ] Board of Ethics
DATE SENT:
BY:
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