HomeMy WebLinkAboutStuibleDane Affadavit Disclosure 2000 1
CITY OF LANSING
AFFIDAVIT OF DISCLOSURE
r o
TO: CITY CLERK
CITY ATTORNEY
BOARD OF ETHICS
C)A Ca
(Name), being duly sworn, says Under
ynder
oath:
1. I am an elected or appointed officer or employee of the City of
Lansing, holding the position of (Title) In the
Department. This position is:
Full Time: Part Time
(Less than 25 hrs. per week)
Unpaid:
2. 1 may derive income or benefit, directly or indirectly, from a contract
with the City or from any City action detailed as follows (Charter 5-505.1):
I AM A PAr: -r Pdk,r 0C: � � ) A ��k Jed �(�tiTs
(Paragraph 2. CONTINUED)
3. 1 have a conflict between a personal interest and the public
Interest, the nature of which 1s disclosed below: (Charter 5-505.2; Lansing
Code 290.04 (1)):
4. 1 have a financial Interest in a matter proposed to be acted upon
by the City of Lansing as described below (Lansing Code 290.04(I):
r
(Paragraph 4. CONTINUED)
5. 1 hav ave no ttached page(s) of additional detail
concerning this disclosure.
6. 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 the day of
(Name)
STATE OF MICHIGAN)
COUNTY OF ) S
Subscri ed an sworn to before me this- - � day of
In County, Michigan.
Nota Pu lic/or
D u Clerk
County, Michigan
y Commission Expires:
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