HomeMy WebLinkAboutBakerJohn Affidavit Disclosure 2002 CITY OF LANSING
AFFIDAVIT OF DISCLOSURE
DATE: G5 Da
TO: CITY CLERK,
CITY ATTORNEY, or
BOARD OF ETHICS
I 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. _ ❑ I am an ❑ elected or ❑ appointed 9fficer or employee of the City of
L ,using holding/the position of ,z) in the
n G / ' Vii — department
❑ 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.
El 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. ❑ 66 1 may derive income or benefit directly from a contract with the City or
from any City action detailed below. (Charter 5-505.1)
❑ 9T1ay 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(l) 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(l) 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 or Ordinances and in the City Charter
3. This position is: 6i7ñiiil time ❑ Part time (less than 25 hours/wk) ❑ Unpaid
4. My Address is: /� �C IC��T �i ��� iGTLr�� /mil G/L•% �S
CONTINUED ON PAGE 2
AFFIDAVIT OF DISCLOSURE-PAGE 2
5. My Business (daytime) Phone # is: 4"8.3 -V,5- 3— ..
PLEASE DESCRIBE IN DETAIL YOUR REASON(S) FOR SUBMITTING THIS DISCLOSURE
6. AND EXPLAIN WHY YOU THINK A CONFLICT MAY/MAY NOT EXIST.
/ - ./4T// V L 7>/rl c s✓r L
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 9210 day of
20_.
u
Signed
State of Michigan, County of ___ l
Subscribed and sworn to before me this 200 Z.
Notary Public/or eputy Clerk
County, Michigan
My Commission Expires: vpumthCowd
!__Comm.Expires May 7.
DRAFT 5A;REVISED 10-09-01