HomeMy WebLinkAboutLeiterRobert Affidavit Disclosure 2018 Q,NS1N
CITY OPLANSING
AFFIDAVIT OF DISCLOSURE
cH1G �'
TO: CITY CLERK DATE:
I }2� � ��n(i r 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. ❑ 1 am an[:] elected or❑ appointed Kofficer or ❑employee of
the Cit�f of Lansing holding the position of
in the Lc,•��M �� e,�— 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
❑ J�J' 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]
❑ 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 of Ordinances and in the City Charter.
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? C4�'C—
CJ c� %
■ Are you self-employed?
■ Who is your employer, if applicable? . fie�s
■ What are the things you actually do in the business? 6") C y
■ Who are your clients and who receives your goods or services? d —
■ How and where are your services performed? Of- ga'
3. M yf
' y of Lansing position is:
Full-time Part-time (less than 25 hours/wk) ❑ Unpaid
4. PLEASE DESCRIBE IN DETAIL YOUR REASON(S)FOR SUBMITTING THIS DISCLOSURE
AND EXPLAIN WHY YOU THINK A CONFLICT MAY/MAY NOT EXIST.
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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 30 :day of G(JoAp,1�
20 _
�--�� - Signed
State of Michigan, County of
Subscribed and sworn to before me this—2A_M day of W UW , 20 I J
KIERAN B,KAKAR Notary Public/or Deputy Clerk
NOTARY PUBLIC,STATE OF MI
COUNTY OFEXPIRES
�VlG1 V1G� VV1 County, Michigan
MY COMMISSION EXPIRES J 116,20n23�
ACTING IN COUNTY OF i vi C;�/�/{ I/V ` My Commission Expires I W I 3 3