HomeMy WebLinkAboutSukovichAngela Affadavit Disclosure 2010 CITY OF LANSING
AFFIDAVIT OF DISCLOSLAA
V o�� � i.
cu/ ~ DATE: /8)
T[I` CITY 7CAtRK,
CITY ATTORNEY, or
BOARD (]FETHICS
\'
make the fol|mwi
/N8[ne\
PLEASE CHECK THE APPROPRIATE BOX OR FILL IN THE BLANKS FOR EACH OF THE
FOLLOWING ITEMS
Yes No
| orn an O e|aoUad or O appointed O officer onnp|oyae of the City of
Lansing holding the t of in the
PA department
O | @nl an immediate family rnannbar related to an elected or appointed
officer or employee of the City Of Lansing named .
holding the position of in the
department.
O ;K | arna Business Associate Of@n elected or appointed officer oremployee
of the City of Lansing named
Holding the position of in the
Department.
2. O 1 may derive income or benefit directly from a contract with the City or from
any City action detailed below. (Charter 5-5O5.1)
O | may have o conflict between 8 personal interest and the public iOiarest,
the nature of which is disclosed below (Charter 5'505.2) [Chapter
#29O.O4(i) of the Code OfOrdinances]
O ) may have ofinancial interest in o matter proposed tObaacted Upon by
the City of Lansing as described below [Chapter28O.O4(/) of the Code of
Ordinances]
O / make this disclosure because of8 possible appearance that | may bein
violation of or in conflict with the City Of Lansing Ethics {}rdiD8OC8 as
provided for in the Code or Ordinances and in the City Charter
3. This position is: o Full time X Part time (less than 25 houne/wk) O Unpaid
4. My Address is:
5. K8y Business (d8vtinne) Phone # is:
CONTINUED ON PAGE
ATTACHMENT A
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? /UCH rJE�
■ Are you self-employed? _/Jo
■ Who is your employer, if applicable? S A-b/5, -e e!-T�f�
■ What are the things you actually do in the business? /'47-CHi57)-)
Pip ,4�)I) se'o V J lx:;, .
■ Who are your clients and who receives your goods or services?
VA42-i
■ How and where are your services performed? VAO__1�5S
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■ If you provide training or education as part of your business:
Do you identify yourself to your clients or students as being employed by
the City of Lansing? �Jc7
Do you include in any of the written materials or aids or reference in any
way in your presentations reference to policies, procedures, methods or
materials as being those also used by the City of Lansing? 0) If so,
attach a copy of the material or aid and explain the reference in your
presentation.
■ Is there any additional information that you believe would assist the Ethics
Board in its review of your business or personal activities for potential
conflicts of interest? f 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.
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