HomeMy WebLinkAboutMattisonMiriam Affidavit Disclosure 2006 RECEIVED
CITY OF LANSING 2906 SEP -5 PH 2: 50
AFFIDAVIT OF DISCLOSURE
ElYNSE'll] CITY CLERK
Date: (Y-/7-6(n
To: City Clerk
City Attorney, or
Board of Ethics
I 1 C i(nm 11 • Ha" 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. ❑ 121 1 am an ❑elected or❑appointed ❑ officer or❑ employee of the City
of Lansing holding the position of in the
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 at the Board of Water and
Light.
❑ 21 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. ❑ CA 1 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(1)of the Code of Ordinances].
❑ ® 1 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).
❑ 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 Ordinances
as provided for in the Code or Ordinances and in the City Charter.
3, This position is: IN Full time ❑ Part time(less than 25 hoursiwk) ❑ Unpaid
4. My address is: 77)y Mrnplel i-rl. owo6So, /9L `/9F&b7
5. My Business (daytime) Phone#is:
17- 70a- Z,17,9
Continued on page 2
-1 -
City of Lansing Affidavit of Disclosure
6. PLEASE DESCRIBE IN DETAIL YOUR REASON(S) FOR SUBMITTING THIS DISCLOUSRE
AND EXPLAIN WHY YOU THINK A CONFLICT MAY/MAY NOT EXIST.
> ti N - �� z
IV UT) mx'
ju
�L
c�
a
o04 � . on 0— r leo�9 150 D $�
1 herby 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 7 day of 200L
CC)
Signed
State of Michigan, County of,
Subscribed and sworn to before me t is 1:7 day p 20 //0 6-
Notary blic Deputy Clerk
County, Michigan
My Commission Expires: / 7 Z
�SEh/WRyWL@NUA11 ...'
Notary Pub9{q Ingham Co.,Uil
DRAFT 5A REVISED 10-09-01 _My Com>r�.4ros Dac.2,.20DE
-2-