HomeMy WebLinkAboutLowndesDavid Affidavit Disclosure 2015 - v
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CITY OF LANSING
L AFFIDAVIT OF DISCLOSURE
ICHIGP
TO: CITY CLERK,
DATE: $` a y-J�
CITY ATTORNEY or
BOARD OF ETHICS
I A'c7c� S 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. ❑ lam an ❑ elected or❑appointed officer or❑ employee of the City of
Lansing holding the position of
in the Polite Department
❑ ❑ I am an immediate family member related to an elected or appointed
officer or employee of the City of Lansing named in the
holding the position of Department
❑ ❑ I am a Business Associate of an elected or appointed officer or
employee of the City of Lansing named in the
holding the position of 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(l) 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]
❑ 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.
3. M City 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. /
L�auvr i� f o f� E L
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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 th' ay f i c.si
20_15�.
Signed
State of Michigan, County of
Subscribed and sworn to before a this 2 day of J 20 1-5
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Notary Publiclor Deputy Clerk
NOTARY MjBW STATE OF County, Michigan
0. My Commission Expires: