HomeMy WebLinkAboutRobinsonA'LynneBoles Affidavit Disclosure 2013 (2) -Z
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TO: CITY OF LANSING
AFFIDAVIT OF DISCLOSURE
CITY CLERK, DATE: O`er f
CITY ATTORNEY or
BOARD OF ETHICS
1 A11,q,l -&cJZ f n S/l 0 make the following disclosure under oath:
�gName)
PLEASE CHECK THE BOX AND FILL IN THE APPROPRIATE BLANKS FOR EACH OF THE
FOLLOWING ITEMS
Yes No
1. ( ❑ I am an selected or❑appointed ❑officer or❑employee of the City of/
Lansing holding the position of ja it G e & viN(0, i[x%ti'
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 in the
Department
❑ 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)
❑ 1 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]
❑ 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(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.
3. My City of Lansing position is:
❑ Full-time t Part-time (less than 25 hours/wk) ❑ Unpaid
4. PLEASE DESCRIBE IN DETAIL YOUR REASONS)FOR SUBMITTING THIS DISCLOSURE
AND EXPLAIN WHY YOU THINKA CONFLICT MAYIMAYNOT EXIST.
6 a a zed
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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 this day of AVVt
Signed
State of Michigan, County of
Subscribed and sworn to before me this day of 20
Notary Publictor Deputy Clerk
County, Michigan
My Commission Expires: