HomeMy WebLinkAboutKrausJames Affidavit Disclosure 2008 CITY OF LANSING
AFFIDAVIT OF DISCLOSURE [; UE I�•,�r-
f u3 SEP 22 f-j 10: Ltg DATE:
TO: CITY CLERK, �- .
CITY ATTORNEY, or _ '.: : . .,-� •.f ! �►�
BOARD OF ETHICS
make the following disclosure under oath:
(Name)
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 ork employee of the City of
Lansing olding the position of /ity7-r.y�0y✓-V— in the
D t I/C�-- department
�1 ❑ I am an immediate family member related to an et�cted or appointed
officer or employee of the City of Lansing named ®y'L�"'��+- 1&i1fz,4;�7
holding the position of 71-z410Sz/1",C- 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. ❑ 1 may derive income or benefit directly from a contract with the City or from
any City action detailed below. (Charter 5-505.1)
❑ 46 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(1) of the Code of Ordinances]
❑ OK 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]
❑ �2 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 or Ordinances and in the City Charter
3. This position is: V Full time ❑ Part time (less than 25 hours/wk) ❑ Unpaid
4. My Address is: dALV-,7
5. My Business (daytime) Phone# is:
CONTINUED ON PAGE 2
i
AFFIDAVIT OF DISCLOSURE-PAGE 2
6. PLEASE DESCRIBE IN DETAIL YOUR REASON(S) FOR SUBMITTING THIS
DISCLOSURE AND EXPLAIN WHY YOU THINK A CONFLICT MAY/MAY NOT EXIST.
40'
Q 77;/i5 7-5-�,dV�i/V
I 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 this I qA day of
20 8�
Signed
State of Michigan, County of /
Subscribed and sworn to before me this NA day of scp�e-itb t?r 20 a f
Notary Public%r Deputy Clerk
�i�C-<l ALL County, Michigan
My Commission Expires:
PLEASE INCLUDE AND SUBMIT A COPY OF YOUR CURRENT JOB DESCRIPTION
DRAFT 5A;REVISED 11-05-04
CITY OF LANSING
AFFIDAVIT OF DISCLOSURE
DATE:
TO: CITY CLERK,
CITY ATTORNEY, or
BOARD OF ETHICS
make the following disclosure under oath:
(Name)
PLEASE CHECK THE APPROPRIATE BOX OR FILL IN THE BLANKS FOR EACH OF THE
FOLLOWING ITEMS
Y s No
1. ❑ 1 am an ❑ elected or ❑ appointed ❑ officer orgemployee of the City of
Lansing �glding the position of ZI s r v�,OnJ ' in the
/��d// �f�, department
❑ I am an immediate family member related to an e cted or appo' ed
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. ❑ r I 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]
❑ 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 or Ordinances and in the City Charter
3. This position is: ❑ Full time ❑ Part time (less than 25 hours/wk) >6Unpaid
4. My Address is:'
/ 7
5. My Business (daytime) Phone#is:
ZiZ - 7��7
CONTINUED ON PAGE 2
AFFIDAVIT OF DISCLOSURE-PAGE 2
6. PLEASE DESCRIBE IN DETAIL YOUR REASON(S) FOR SUBMITTING THIS
DISCLOSURE AND EXPLAIN WHY YOU THINK A CONFLICT MAY/MAY NOT EXIST.
- �nbW14d4i
hereby certify that this disclosure is complete-and dccurat6'to'tft'bas4f'rny o_ "'ki' ' e,
information and belief.
.-The foregoing Affidavit of Disclosure was executed on this
20_Q.2 day of
Signe
State of Michigan, County of
Subscribed and sworn to before me this day of SC j2kk.( vr '2007
AvIl— Notary Publiclor Deputy Clerk
County, Michigan
My Commission Expires:
PLEASE INCLUDE AND SUBMIT A COPY OF YOUR CURRENT JOB DESCRIPTION
DRAFT 5A;REVISED 11-05-04