The URL can be used to link to this page

Home My WebLink AboutLaCrossJon Affidavit Disclosure 2018 CITY OF LANSING AFFIDAVIT OF DISCI-QS99 . ,11', ID TO: CITY CLERK, ` r2� � I CITY ATTORNEY, or MAY BOARD OF ETHICS GAL �LD f make th o 1�pg�1"isalo:sure l t (Name) r— r�` crt 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 or Elemployee of the City of Lansing holding the position of F0 cfr-7E oFF�- z in the Pot � jm� 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. ❑ 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. ❑ 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(1) 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 art time (less than 25 hours/wk) ❑ Unpaid 4. My Address is: 5. My Business (daytime) Phone# is: CONTINUED ON PAGE 2 AFFIDAVIT OF DISCLOSURE-PAGE 2 PLEASE DESCRIBE IN DETAIL YOUR REASON(S) FOR SUBMITTING THIS 6. DISCLOSURE AND EXPLAIN:WHY YOU'THINK A CONFLICT MAY/MAY NOT EXIST. Dp ,-- r4- n (D*! 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 s'� day of faL 20 l a Signed State of Michigan, County of / Subscribed and sworn to before me this st day of l7�� 201D Notary Public%r Deputy Clerk N��fRe� County, Michigan My Commission Expires: PLEASE INCLUDE AND SUBMIT A COPY OF YOUR CURRENT JOB DESCRIPTION DRAFT5A;REVISED 11.05.04 ATTACHMENT A 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?rj�c�P—P4> .�� ■ Are you self-employed? y£S Who is your employer, if applicable? 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? ►'l0�'� 5 + � fir-" Page 1 of 3 ■ How often do you do outside work? 2� Does your business or employer contract with the City? NP In performing your business or outside employment, do you use any City facilities or equipment? If so, describe: Is any of your business or employment conducted in the City? `� If so, describe: Sfy ALA -Palir'Is C Does your business advertisement or circulars, if any, contain any reference to the City or your City employment? !� ■ If your business uses advertisements, circulars, applications, or order forms that you have designed or have had designed for you, please attach a copy of the applicable form(s). Page 2 of 3 If you provide training or education as part of your business: Do you identify yourself to your clients or students as being employed by the City of Lansing? All /ft- Do you include in any of the written materials or aids or reference in any way in your presentations reference to policies, procedures, methods or materials as being those also used by the City of Lansing? If so, attach a copy of the material or aid and explain the reference in your presentation. A l A- Is there any additional information that you believe would assist the Ethics Board in its review of your business or personal activities for potential conflicts of interest? 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. Page 3of3 CITY�O`F`T 4SIfi1G L' v J AFFIDAVITc OF-DISCLOSURE, I� xt � TO: CITY CLERK DATE: I��c,,.1 �p 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. I am an ❑elected or❑ appointed 4officer or❑employee of the City of Lansing holding the position of o'xcF' oxj Czf--- in the -�1eV`� 'i� f v UKI, 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 ❑ 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. ❑ I 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] ❑ V/ 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] ❑ 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. To Whom it may concern, I received a gift from a gentleman named James Leyrer on 12/21/2017. James Leyrer is a Lansing resident that resides in the neighborhood I used to patrol as a Community Police Officer. James was responsible for a significant amount of calls for service due to mental health and alcohol problems. James is also a veteran. James was on probation through the Ingham County Probation under 54A DC. I had Jim's probation transferred to the Veterans Court in East Lansing. This enabled Jim to become eligible for several services. As a result,Jim was able to turn his life around and has been sober with January marking his 1 year anniversary. In addition, during this time the neighborhood became quieter and the calls for service stopped. This was documented in a Blue Team entry for my personnel file from Capt Southworth. Jim told me in numerous phone conversations that we have that he was going to buy me a watch. I strongly urged him not to and told him that by merely staying sober were thanks enough. James attempted to give me the watch on another occasion while I was on a call in the neighborhood. I didn't accept it. James dropped the watch off at City Hall and told them it was for me. I immediately contacted Chief Yankowski and notified him of the gift. Under the direction of the Chief I am writing this Memo to notify the Ethics Committee of this. I am honored to have received this gift from James but I also understand that we as public servants shouldn't accept gifts from the citizens we serve. I am looking for guidance on what to do with the watch. Included in this memo is a picture of the watch with the receipt that he included in it. clue (aSi%1) SHAUN "11 a n . 057 OWN:. MI 1111011' Ot'.S6 i001 0a13'i Ob0 e,ro CANo\ "tlrt►!3 CRi1J N0.10 t , {111q 3YR SERY Pl SOrla(AL 160.1/ 4 {At l b.000 1 y.00 IOUI 113.11 eA1U nAa�xUkO M Mull 113.13 'Sol. L\t011 cqM 00tR I$$ so t01\t 16o'. CRfYt reatMO1:..• 24l1 i 1 NutuC.t• ' 113.l0 P 000UE 160.01 LOSM 11C[ r ► Ar11) moii,. 000�iY PYIJt!<431 *. 010 10101111111011 IC 0119640/61I/OCOS 1E1M1rat 0 SCO1031/ .NB S10M0101E 1E10110EmiliE O01 t00.00 Yt.lt tsescluh.cua to %.. to # ITEMS SOL 2 .1L0 1111 5trt 1095 Happy to Help s,T Y q lIENIER COPY ••• 3. My City of Lansing position is: P Full-time ❑ Part-time (less than 25 hours/wk) ❑ Unpaid 4. PLEASE DESCRIBE/N DETAIL YOUR REASON(S)FOR SUBMITTING THIS DISCLOSURE AND EXPLAIN WHY YOU THINK A CONFLICT MAY/MAYNOT EXIST. I hereby certify that this disclosure is complete and accurate to the best of my knowledge, information and belief. The fo going Affidavit of Disclosure was executed on this , day of ual- , 20 Signed State of Michigan, County of Subscribed and sworn to be r e this day of MAcla 2o,'-ii Notary Public/or De uty Clerk MICHELLE R. REDDISH �--��NOTARY PUBLIC-STATE OF MICHIGAN County, Michigan COUNTY OF INGHAM � A My Commission Expires October 3,2019 My Co Ission Expires: Acting in the County of