HomeMy WebLinkAboutLopezGuillermo Affidavit Disclosure 1995 CITY OF LANSING :'I_
AFFIDAVIT OF DISCLOSURE T
OF t :;
CONFLICT OF INTEREST
L1( i CLERK
TO: [ ] CITY CLERK or
[ J CITY ATTORNEY and
[ ) MAYOR and , DEPARTMENT HEAD or
D(j CITY COUNCIL PRESIDENT
(Name) � Ci lermo Z. lcla' - 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 (Title) �O0 l I'le) g� fVT i�tif t.
its in the rf"[�muvi l K`�lff d6l'i 1
Department. This position is : [kf Fulltime [ ] Parttime ( less than
25 hours/wk) [ ] Unpaid.
2. [ ] I , [ ] and/or my (Relationship) ,
a member of my immediate family as defined in Ordinance 290 . 02 ( i ) ,
[ ] and/or (Name)
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
1
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
pecuniaryL interest ) :
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;and/or
[✓j" 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 ) :
2
;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) [ ] 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:
3
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 Disclosure of Conflict of Interest
was executed on the �t`I day of 19 � ^
Subscribed and sworn before me the day of �
19g5 , in County, Michigan
Notary Public/or
DIXIE L. GILMORE Q Deputy Clerk
Notary Public, Ingham County, Mi A17_ri, County, Michigan
My Comm. Exrpi''�,?^ May 28, 1999 My Commission Expires :
FOR CITY CLERK/CITY ATTORNEY USAGE
DATE FILED: June 8, 1995
COPIES SENT TO: [ Mayor
[ City Council President
[ Department Head
[ Board of Ethics
DATE SENT: June 9, 1995
BY: Marilynn Slade
4
TO THE ,C Z
BOARD
Lansing - Board of Ethics
TO: Council President Benavides and Fellow Councilmembers
FROM: Marilynn Slade, Secretary, Board of Ethics ,S
DATE: June 9, 1995
SUBJ: Affidavit of Disclosure: Guillermo Lopez
Enclosed is an Affidavit of Disclosure filed by Guillermo Lopez on 6/8/95. Copies have
been sent to the Mayor, Department Head and Board of Ethics.
(517) 483-4130 City Clerk's Office, 124 W. Michigan Ave. Lansing, MI 4 893 3-1 695
CITY OF LANSINGr��1��ED
AFFIDAVIT OF DISCLOSURE
OF ° ; 3- 53
CONFLICT OF INTEREST
LAP'S1�G CITY CLERK
TO: [ ] CITY CLERK or
[ J CITY ATTORNEY and
[ ] MAYOR and - , DEPARTMENT HEAD or
CITY COUNCIL PRESIDENT
(Name) d u r j e r m o Z. 10'4- being duly sworn,
says under oath:
1. I am an elected cr appointed officer or employee of the
City of Lansing, holding the position of (Title) E�Kj DP&7T
�Pa c n s in the "M am �01 6 r-n S iY►il1 Gil?/ j _a o zej I t
Department. This position is: [;!"'Fulltime [ ] Parttime ( less than
25 hours/wk) [ ] Unpaid.
2. [ ] I , [ ] and/or my (Relationship) ,
a member of my immediate family as defined in Ordinance 290 . 02 ( i ) ,
[ ] and/or (Name)
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
1
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 ) :
e s 5 `,Yra r 0--,
W J
(4_� *^A_ i Ii m Vr du S
77
;and/or
[v]� 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 :
fu
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 ) :
2
;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) ( ] 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:
3
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 Disclosure of Conflict of Interest
was executed on the $ day of 19 �S
/' J
Subscribed and sworn before me the 8l day ofY�.Q�
19gS in County, Michigan I
Notary Public/or
DIXIE L. GILMORE Deputy Clerk
Notary Public, Ingham County, MI County, Michigan
My Comm. Expi•PF May 28, 1999 My Commission Expires ; a�j r16�
FOR CITY CLERK/CITY ATTORNEY USAGE
DATE FILED: June 8, 1995
COPIES SENT TO: [4 Mayor
[ City Council President
( Department Head
[ Board of Ethics
DATE SENT: June 9, 1995
BY: Marilynn Slade
4