HomeMy WebLinkAboutPerry-BuseHelen Affidavit Disclosure 1999 CITY OF LANSING
AFFIDAVIT OF DISCLOSURE
TO: CITY CLERK
CITY ATTORNEY
BOARD OF ETHICS
(Name), being duly sworn, says under
oath:
1. 1 am an elected or appointed officer or employee of the City of
Lansing, holding the position of ��� � � 5\k4-Title) in the
Department. This position is:
Full Time: Part Time
(Less than 25 hrs. per week)
Unpaid:
2. 1 may derive income or benefit, directly or indirectly, from a contract
with the City or from any City action detailed as follows (Charter 5-505.1):
�sra6Ai otz
(Paragraph 2. CONTINUED) , ry y2J;\l1tL� \ so�A� C��es �ANc� n� s2 Wot�ct ` eN1_S,
PS A,
3. 1 have a conflict between a personal interest and the public
interest, the nature of which is disclosed below: (Charter 5-505.2; Lansing
Code 290.04 (1)):
4. 1 have a financial interest in a matter proposed to be acted upon
by the City of Lansing as described below (Lansing Code 290.04(I):
(Paragraph 4. CONTINUED)
5. 1 have/ ave nol ttached page(s) of additional detail
concerning this disclosure.
6. 1 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 the�day of
(Name)
STATE OF MICHIGAN)
) SS.
COUNTY OF ,
Subscr' ed nd sworn to before me this 2 day of
19M in __ ounty, Michi
a.Q l>>
Notary Public/or
Deputy Clerk
County, Michigan
My Commission Expires:
DEBORM K MER
Mola.ry Public,tnoli m Coumy,M7
My Comm.Px¢Irc,;,Dec. 12, i$99