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HomeMy WebLinkAboutStittKeegan Affadavit Disclosure 2017 (2) N S I�'c CITY OF LANSING AFFIDAVIT OF DISCLOSURE c .-- t TO: CITY CLERK DATE: e'D6-/7 Fri C7 �, r .. rn I �GAN �� �ri rr make the following disclosure under oa'h: (Name) PLEASE CHECK THE BOX AND FILL IN THE APPROPRIATE BLANKS FOR EACH OF THE FOLLOWING ITEMS Yes No 1 ❑ 1 am an ❑ elected or❑ appointed ❑ officer or$employee of the City of Lansing holding the position of S&ece4nr; in the Pine 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 ❑ 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. ❑ l4 I 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) ❑ 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] 04 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 Ordinance as provided for in the Code of Ordinances and in the City Charter. 3. My City of Lansing position is: Full-time ❑ Part-time (less than 25 hours/wk) ❑ Unpaid 4. PLEASE DESCRIBE IN DETAIL YOUR REASON(S)FOR SUBMITTING THIS DISCLOSURE AND EXPLAIN WHY YOU THINK A CONFLICT MAY/MAY NOT EXIST. 6 N.07- &Z-r EvE 747- 14 e o^je2 sr o f 4-r y Suer s rs . I 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 Agl(_ , 20 . PP Signed State of Michigan, County of Subscribed and sworn to before me this day of Q ;, , 20 / A f Notary ublic/or Deputy Clerk NANNETTE M MILLER �� l_ Neta y Public - Michigan �l►�ln(Y'1 County, Michigan Clinton County M Commission Expires: ' My Commission.Expires A 1, 2021 Y p I' I Acling in tr�.e County of ( _(1` ATTACHMENT TO AFFIDAVIT OF DISCLOSURE Please provide additional information about your outside business or employment. Of special interest to the Board is how the activities of the business or employment may directly or indirectly affect the City. This disclosure is about information and is not an indication of any anticipated conflict of interest or suspected wrongdoing. Therefore,please describe for the Board what it is you actually do and be detailed and specific. You are not required to limit your disclosure only to the following questions. For each business, include in your answer such things as: ■ What is the form of your business entity and what percentage do you own? PJ11 t & 4N 1 r PZ eYC6 OF- ,�J FL �D�/OR ('6111 9/A //,'4I1V>N61 5� % ■ Are you self-employed? 11/C ■ Who is your employer, if applicable? L NaN0lz �uAA,6 7A41,Vj^f,1 ■ What are the things you actually do in the business? J 1l?,Al.1 r/L5 IZ�SPo.�t�EIS �LN onl0� ('?UA�Z6 A o 6RE1t0.j,,AZ- OPCIe4 F,,(G.,J S . ■ Who are your clients and who receives your goods or services? Anr IS EMS p,eeS C,nf'V eL �M j/A e!o vS awelES • How and where are your services performed? SERvle-ES Wit-L &c PRgMF'-'N 14-AAm , Mt . �Gr�e. h Sri • How often do you do outside work? heAIIVIAei ]'ak SvivE - Zv 17 . ■ Does your business or employer contract with the City? A/o ■ In performing your business or outside employment, do you use any City facilities or equipment? S If so, describe: -7;,rrEni b To W EAR, Al y /40No2 6vAKJ AQ(FeAM ON TE R^JAL. 6Ay DF TRAi•JrNC, - boer,.,je., A S►,,tv"r&, �� e--No'-j S&kvice. • Is any of your business or employment conducted in the City? /'Aw If so, describe: • Does your business advertisement or circulars, if any, contain any reference to the City or your City employment? Al/0 • Is there any additional information that you believe would assist the Board of Ethics in its review of your business or personal activities for potential conflicts of interest? A16 If so, please describe: In providing this additional information, the Board of Ethics asks that you give special attention to the Conflicts of Interest section of the Charter found at 5-505.1 — 5-505.3. A copy is enclosed for your convenience. N S I`�c CITY OF LANSING AFFIDAVIT OF DISCLOSURE �� N TO: CITY CLERK DATE: �d�-/7 —f rn r .. rn 1 77 rT make the following disclosure under oafi: (Name) PLEASE CHECK THE BOX AND FILL IN THE APPROPRIATE BLANKS FOR EACH OF THE FOLLOWING ITEMS Yes No 1. ❑ I am an ❑ elected or❑ appointed ❑ officer orXl employee of the City of Lansing holding the position of S&ec;t-4yv in the Pine 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. ❑ �4 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) ❑ 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 of Ordinances and in the City Charter. 3. My City of Lansing position is: Full-time ❑ Part-time (less than 25 hours/wk) ❑ Unpaid 4. PLEASE DESCRIBE IN DETAIL YOUR REASON(S)FOR SUBMITTING THIS DISCLOSURE AND EXPLAIN WHY YOU THINK CONFLICT MAY/MAY NOT EXIST. 416 N07T 3,c41FVC_ 7N•FT' 14 C'o.v{2�e_?- of 4&1 y Saes SXt 5 7T5 . I hereby certify that this disclosure is complete and accurate to the best of my knowledge, information and belief. i The foregoing Affidavit of Disclosure was executed on this day of . 12/t , 20�. � Signed State of Michigan, County of �c11.1 Subscribed and sworn to before me this_ Ia_'�"day of QJ) ;, , 20�_ Notary Public/or Deputy Clerk NANNETTE M MILLER Notary Public - Michigan County, Michigan Clinton County My Commission Expires A 1,20 My Commission Expires: Acting in the County of�V__(('�4111 ATTACHMENT TO AFFIDAVIT OF DISCLOSURE Please provide additional information about your outside business or employment. Of special interest to the Board is how the activities of the business or employment may directly or indirectly affect the City. This disclosure is about information and is not an indication of any anticipated conflict of interest or suspected wrongdoing. Therefore, please describe for the Board what it is you actually do and be detailed and specific. You are not required to limit your disclosure only to the following questions. For each business, include in your answer such things as: ■ What is the foam of your business entity and what percentage do you own? ..Z' d✓lG L �� A,v CMPca EE aF F� //D�n�Z vA RA TgININC� ; % / ■ Are you self-employed? /1/0 ■ Who is your employer, if applicable? JVL &1409 6u,4/Zls ZA-404/,41/7 ■ What are the things you actually do in the business? // W 11-L 72A/nl r2S-I- 965POAf6 69S J� J I7WO P, 6A,e6 4,'� Ai ,Clttolu,,AL 0,,5,FR4 c (5 . ■ Who are your clients and who receives your goods or services? youc� , �2E A�r,s E�s Peres C stir 1144/4oS • How and where are your services performed? SEi2VlCE S 0/1-L ,g£ • How often do you do outside work? ■ Does your business or employer contract with the City? A/o ■ In performing your business or outside employment, do you use any City facilities or equipment? ES If so, describe: --E T_,,v,—END T W EAR Al y flUryo2 60AI�J OJIFeAki ON 7WE R^IAL 6Ay of 7RA/NrNC� - buia(A1C, A SI-toga,& ;aL-NO^jalZS -zNEPAt- Se'evieE • Is any of your business or employment conducted in the City? A/v If so, describe: • Does your business advertisement or circulars, if any, contain any reference to the City or your City employment? /l/o • Is there any additional information that you believe would assist the Board of Ethics in its review of your business or personal activities for potential conflicts of interest? A/o If so, please describe: In providing this additional information, the Board of Ethics asks that you give special attention to the Conflicts of Interest section of the Charter found at 5-505.1 — 5-505.3. A copy is enclosed for your coovemence.