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HomeMy WebLinkAboutToppingSusan Affadavit Disclosure 2004 City of Lansing - Board of Ethics TO: Susan M. Topping, Senior Accountant, Finance Dept. FROM: Marilynn Slade, Secretary, Board of Ethics � � DATE: September 28, 1994 ' SUB7: Affidavit of Disclosure of Conflict of Interest The Board of Ethics reviewed your Affidavit of Disclosure of August 1, 1994, at its meeting of September 27, 1994. We appreciate your bringing this to our attention. The Board received and placed your Disclosure on file. No further Board action in this matter is anticipated at this time. (517) 483-4130 City Clerk's Office, 124 W. Michigan Ave. Lansing, MI 48933-1695 CITY OF LANSING AFFIDAVIT OF DISCLOSURE OF CONFLICT OF INTEREST TO: CITY CLERK or [ ] CITY ATTORNEY and [ ] MAYOR and , DEPARTMENT HEAD or [ ] CITY COUNCIL PRESIDENT (Name) .5USS4y PL R)PPitiC- being duly sworn, says under oath: 1. I an an elected or appointed officer or employee of the City of Lansing, holding the position of (Title) Acocuk1 —) fuT in the t-1hjAt�'C.� Department. This position is: [A Fulltime [ ] Parttime ( less than 25 hours/wk) [ ] Unpaid. 2. [ ] I , [ ] and/or my (Relationship) a member of my immediate family as defined in Ordinance 290 . 02 ( 1 ) , [ ] and/or (Name ) , a business with which I am associated as defined in Ordinance 290 . 02 (b) , ( c) and (d) : (Select the option or options that apply) [ ] a. may receive a financial benefit of more than a de minimus. nature which is distinguishable from the benefits to the person as a member of the public or as a member of a broad segment of the public from a decision I would otherwise make or participate in as an officer or employee. The decision involved is described as follows: The financial benefit will be received by the following persons in the following amounts: ;and/or [ ] b. intend to have business dealings with the City of 1 Lansing, either directly or indirectly. The business dealings are specifically described in detail as follows ( include names of each party, the duration of the dealings, the financial consideration between the parties, the governmental facilities or services involved, the nature and degree of assignment of government employees for fulfillment of ,dealings, and the nature of any pecuniary interest) : G �� 1--/�A. ;and/or [ ] c. may derive income or benefits, either directly or indirectly, in addition to official remuneration, as a result of Council action. The action involved is described as follows: The income or benefits , in addition to official remuneration, that will be derived, either directly or indirectly, is described as follows : ;and/or [ ] d. may derive income or benefits, either directly or indirectly, in addition to official remuneration, as a result of a contract with the City. The contract is specifically described in detail as follows (include names of each party, the duration of the dealings, the financial consideration between the parties, the governmental facilities or services involved, the nature and degree of assignment of government employees for fulfillment of the contract, and the nature of any pecuniary interest) : 2 ;and/or [ ] e. have a conflict between a personal interest and the public interest as defined by state law, the Lansing City Charter, or ordinance. The personal interest that conflicts with the public interest is described as follows : The public interest that the personal interest conflicts with is described as follows : 3. I have attached additional detail on the reverse of this form or on attached sheets, including copies of all relevant documents, memos, resolutions, . and contracts. 4. (Select One) [ ] I will not make or participate in the . making of the affected decision and/or governmental decisions concerning the contract and/or governmental decisions . concerning the business dealings and/or governmental decisions concerning the conflict, OR [ ] Despite the conflict of interest, I am able to make or participate in the making of the affected decision and/or governmental decisions concerning the contract and/or governmental decisions concerning the business dealings and/or governmental decisions concerning the conflict, fairly, objectively, and in the public interest because: 3 5. I hereby certify that this disclosure is complete and accurate to the best of my knowledge, information and belief. 6. I_ .here.b•y certify that I have not solicited or entered into any agreement with the City of Lansing prior to filing this affidavit. The foregoing Affidavit of Disclosure of Conflict of Interest was executed on the 19 i 15f day of �l t SG7i l / Subscribed and sworn before me the (�••T day of [ Gc1. 'i► 1914 in � NCO,-q ,k/1 County, Michigan , Notary Pub is/or Deputy Clerk DESOFMW"AgR Michigan My COMRMJ4 %AA<p WC-bunty, MI Ac3ing in Ingham County,A dOW My Comm. EXpum Feb, 20, 109 FOR CITY CLERK/CITY ATTORNEY USAGE DATE FILED: COPIES SENT TO: Mayor �J City Council President [ Department Head c, L' Board of Ethics DATE SENT: BY: 4 Prepared By Approved By ©WILSON JONES COMPANY G7204 GREEN 7204 RUFF MA, 1 2 3 4 2 2 3 L, JU ( 3 4 4 // 5 (� / / 5 6 6 7 IAU 1AZcjmC- 7 6 B 9 UCT i10 / 9 10 10 11 (� �(JL.L T//Y>E / l 11 12 y� 1 / 12 13 /VS/ C r l 13. 14 14 15 15 16 16 17 5 17 18 18 19 19 20 20 21 7� / 21 22 22 23 — 23 24 24 25 25 26 26 27 f 27 28 28 29 29 30 30 31 31 32 32 33 33 34 34 35 35 3G 36 37 37 38 38 39 39 40 40 Initials Date Prepared By Approved l3y JONES COMPANY G7204 GREEN 7204 BUFF MADE IN U.S.A. 1 2 3 4 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 10 1 11 2 12 3 13 4 14 5 15 6 16 7 17 8 18 9 19 0 20 1 21 2 22 3 23 4 24 5 25 6 26 7 27 B 28 9 29 0 30 1 31 2 32 3 33 4 34 5 35 6 36 7 37 IIH 1, I ' ll B 38 9 39 0 40 CITY OF LANSING AFFIDAVIT OF DISCLOSURE DATE: TO: CITY CLERK,- -' CITY ATTORNEY, or BOARD OF ETHICS (IPA 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. o ❑ I am an ❑ elected or ❑ appointed ❑ officer or © employee of the City of Lansing holding the position of.��-A�� ,T/��75�tr19v in the �/l PO,sGi k t; I Ir)((,'-)k( /ZL C— department r i-li e /ia ❑ ❑ 1 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. ❑ ❑ 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(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] o ❑ 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: d Full time ❑ Part time (less than 25 hours/wk) ❑ Unpaid 4. My Address is: CONTINUED ON PAGE 2 AFFIDAVIT OF DISCLOSURE-PAGE 2 5. My Business (daytime) Phone # is: 517- -3 -1 OJ 3 PLEASE DESCRIBE IN DETAIL YOUR REASON(S) FOR SUBMITTING THIS DISCLOSURE 6' AND EXPLAIN WHY YOU THINK A CONFLICT MAY/MAY NOT EXIST./l /2 Au rr�S - Wye 4t V 0"zW`zCl i tlx k UYL- 0?5/.s 7 in 71, ..,a e ✓U/l15 Ova c�'fl��t. �� ✓�c� t 740 GU Q` S -74 • A)LM nn r &/i�1-A/it 46 6_t' 6"n1 b 4 YL Lc1.� 1� 6(lg s l 1 : c1 211'r' " h/ t� &0 5 Ine s 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 this day of OLfDY 20 r_ - Signed State of Michigan, County of Li n 1 o n ,gC,4i �n Subscribed and sworn to before me this dav,of O C fc3 r 20 d NotaijP-Whr,14 Deputy Cleric County, Michigan My Commission Expires: CHERYL J. GOX Notary Public, Minton Count}, M1 DRAFT 5A;REVISED 10-09-01 My Comm. Expire.S Feb.26.2008