HomeMy WebLinkAboutSalimMary Affidavit Disclosure 2005 CITY OF LANSING
AFFIDAVIT OF DISCLOSURE
Date: May 25, 2005
To: City Clerk
City Attorney,or
Board of Ethics
I Mary Salim 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. ❑ X I am an ❑ elected or❑ appointed ❑ officer or❑ employee of the City
of Lansing holding the position of in the
Department.
J4! ❑ 1 am an immediate family member related to an elected or appointed
officer or employee of the City of Lansing named Nadim Salim,
holding the position of Stock Distribution Specialist at the Board of
Water and Light.
❑ X 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 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: ❑ Full time %Part time (less than 25 hours/wk) ❑ Unpaid
4. My address is:1730 Lindy Drive Lansing, MI 48917
5. My Business (daytime) Phone# is:517-323-3143
CONTINUED ON PAGE 2
6. PLEASE DESCRIBE IN DETAIL YOUR REASON(S) FOR SUBMITTING THIS DISCLOUSRE
AND EXPLAIN WHY YOU THINK A CONFLICT MAY/MAY NOT EXIST.
I am married to Nadim Salim a BWL storeroom employee. I wholesale an angle bracket used to hold
meters. I would like to sell them to the BWL for use in their lead service replacement program
My husband is an employee of the department that warehouses these products. He does not
have any part in purchasing these items installing them or evaluating their quality. However I wanted to
disclose this relationship prior to selling to the BWL.
I 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 �� day of 20�
Sign
State of Michigan, County of
r`
Subscribed and sworn to before me this i'h da of 20 V
f-#AAAJ�iA A
Notary ublic Deputy Clera
County, Michigan
My Commission Expires: • Q
DRAFT 5A;REVISED 10-09-01