HomeMy WebLinkAboutSchwarzJeff Affadavit Disclosure 2015 XVB4d
I
CITY OF LANSING
AFFIDAVIT OF DISCLOSURE
Date; I1- CD - i3
To:. City Clerk
City Attorney, or
Board of Ethics
I e-I.,wnti2 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
7 n
1. ;9 ❑ I am an ❑ elected or❑ appointed ❑ officer orb employee afdhe 44Y M
6f Lansing holding the position of?r J7s Cca+"(1£+. in tfaei -n
,IEet SEA-VICES Department. "� M
L13W11 c
❑ 1 am an immediate family member related to an elected or a intee
officer or employee of the City of Lansing named holr g
the position of at the Board of WatG an
Light.
❑ ® 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. ❑ ® 1 may derive income or benefit directly from a contract with the City or
from any 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(1) of the Code of Ordinances).
❑ k7 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].
'�4 ❑ 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 Ordinances
as provided for in the Code or Ordinances and in the City Charter.
3, This position is: 'R Full time ❑ Part time(less than 25 hours/wk) ❑ Unpaid
4. My address is: 1 3 S, wnsL„ �p�v.v (eve. [,ps,�,�.5 M�- t-P¢9 t n
5. My Business (daytime) Phone
Continued on page 2
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.
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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 �O day of 203
Signed
State of Michigan, County of
Subscribed and sworn to before me this day of 20 l3
Cl._
Notary Public Deputy Clerk
SHONI GALATIAN.
NOTARY PUBLIC-STATE OF MICHIGAN ��`
COUNTY OF CLINTON CA 171i— County,Michigan
My Commission Expires Mpr.5,2017
Acting in the County of ��'� w.
My.Commission9---xpires: e 1a.`e SI 2 t
DRAFT 5A REVISED 10-09-01
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