Loading...
HomeMy WebLinkAboutSchulteMichael Affadavit Disclosure 2013 (2) CITY OF LANSING AFFIDAVIT OF DISCLOSURE DATE: TO: CITY CLERK, CITY ATTORNEY, or BOARD OF ETHICS I P/l, / �F! l 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. ❑ I am an ❑ elected or ❑ appointed 0 ffift er or ❑ em loyee of the City of Lansing holding th position of �� c Z-ei 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. ❑ i I 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(I) 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 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: 5. My Business (daytime) Phone # is: CONTINUED ON PAGE 2 AFFIDAVIT OF DISCLOSURE-PAGE 2 6. PLEASE DESCRIBE IN DETAIL YOUR REASON(S) FOR SUBMITTING THIS DISCLOSURE AND EXPLAIN WHY YOU THINK A CONFLICT MAY/MAY NOT EXIST. c vc L.14 I hereby certify that this disclosure is complete and accurate to the best of my knowledge, information and belief. The foregoin. ,,,A,.ffidavtt�.ofw4liselosttre—wqs executed on this 94 �l day of 20 Michelle R. Reddish, Notary Public ,,, state of Michigan,County of Ingham z My Commission Expires 10/3/2013 Acting in the County of Signed State of Michigan, County of Subscribed and sworn to before me this day of 9 / 20 /3 Notary Public%r Deputy Clerk 01--� County, Michigan My Commission Expires; /0 -3.r PLEASE INCLUDE AND SUBMIT A COPY OF YOUR CURRENT JOB DESCRIPTION DRAFT 5A;REVISED 11-05-04 Affidavit of Disclosure Attachment A.pdf 1TEAGHMENT A Piease:provide.additiorrai irtformatiori:.at out your dutside buslress;or -errtp[oym-erit. :Of.spee1ai.Interest:fo 1 he'Board [ h:otiv fhe activities of the:business or em..bli Nrnent Tnay:directiy or-.iridirecf€ :affect:the City. Tk�s:distiosure. [s.aboaf iri;fo tiorr.:aad is riot:arr iridlcatiot of:any'tic...ipated.D. rnfiic t.bf interest:ar :. suspected v iortgdoing ThiBrefole,,pieas6.describe°tbrIhe:.Board vuhaf if:is yob :,addu ,_y:do and;be:detalied' artd specific.. YfQu-are€ot�regbired to limit-your : disci©sure only tQtfe.fdltenrirlg gesors. For:each biasiruess, In.clrJde [ .:your . answer such ttiirigs as, What is:the form of�yopr`b[rsleess.::gntrty::and what peccefttage do 4 d dLo Areyouu;aeff-erlpioye . .........e....... ...... . . _ AA..... .........:.:. Vt+ho, §-:your.ernpiq er, if., ppiicable Whaf ar.:e theth(rfgs:;ypu:aefualfy 'o tf e basr€tess _ . ........... ......... ........................... .... �.o-are your: fs°arrd ho.ir cei€es year good : orselvices : tie � ' � ....... .................... ...... ............... ........... ,.Nov�.and where :aFe:your.se McPs peffar ed Page�1 of https:t/ow&lansing mi.g ov/owa/WebReady\riew.asp)C�-att&id=RgAAAADX%2b5AbY42kTLJDhU NvpSAeBwAbb%2bQhlf6onNcBYJ5)cmAAAAwaAvAAAbb%2b... 1/1 L4/1516 Am clam t or Ulsclosure AUachment_A.pdt Hove often do:: ou:dQ outside:world? LILA✓ Does:your business::or.empI :r. �antract t Ah*t e City? . ...... ........ . In'Rerrorml g .your btr5[rtess or:outside-ern Ioy ment :pia your rase any Gity faei[itios or equipment if skAescribe: sang:ofyyaur`:bl�s� ess.or ernployrn rrt conducted ire fhe;Gity If sa, I :.dose:ibe: ae 4 . �:oes your r si€tess adverb semen or cir lars; if arty; eort-ain ar>-y rferartce to ttte ClraryE€r G�fr ertplen. . If iar .uu fh.. uses advetsid er ts, tircutars, app vgatfOns, or.r.er forms that you,have-{tesrgned or €�av h_adf d.o gned foryoo;; please attach copy:oF tkte pplicable far n.(q). https://owa.l ansi ng mi.g ov/owa/WebReadyVi ew.aspx'?t=att&i d=Rg AAAADX%2b5AbY42kT W D hU N vpSAeBwAbb%2bQhlf6yR I nN c8xJ 5xc;mAAAAwaAvAAAbb%2b... 1/1 114/15/,13 AMCJawt or uisciosure /it[acnmeni /-.por ffyou,provid.e.training or ed:ucatii:on as pen of ur:business. ao.you ideutifyyourself to your.clients:orstud.enttsiias;bb[ng:ernpfoy/ed 'b}i :.the :of Lensing? 44&L,� 1 N Cit, Z�14�4. V__ Do lou inciude in airy of.the,:wriiler> materi.ais::er aids or referee-ce: in any. uway.in}!or r:prese€fatrons::.r ference ap:c lici�s, pro ed€res;..me ods•or materials as'berng bl ase-also used bythe Gift of L si€tg7:_ 1f o; altach :a copjr ofth.mi aterfai or-aiel ai d ex'[' the€6feF.tri�e:frf y;at r presen'taf ore: . lsthere:aoy addit.dnal i:nforrnatio�.that:.yoq b Iieue woald as§st p:e Elhi es Board'in [ts.raview...afyocir:bsirress ar.personal .acivifies. or potentfa€ eQnfiicts of interest? Please deserba_.:.. lh..prov ding this addition-ai.:informatio'n-the Baard of'Elhirs:.asks tf at YOU give species-ttenfibn tgthe Conflicts of intei-esi secfi!oh. ofthe Charter fouhd;.at:','.-. .505_1- 5-5G5:.3_ A:copy is:enciosed for:yocur.co�zvenienc_ Pa9`e:3::of:3: https://owa.1 ansing mi.g ov/owa/WebReadyView.aspx?t=att&id=RgAAAADX%2b5AbY42kTLJD hU NvpSAeBwAbb%2bQhlf6yR InN c8xJ5�mAAAAvvaAvAAAbb%2b... 1/1