HomeMy WebLinkAboutCannonTerry Affidavit Disclosure 2022 tiPN S 1 �C
CITY OF LANSING
AFFIDAVIT OF DISCLOSURE
CHiGP
TO: CITY CLERK DATE: L / 1 7 /2o 2Z-
I, _1 Tr r c C r C;ti ,w make the following disclosure under oath:
Na a (please print)
PLEASE CHECK THE BOX AND FILL IN THE APPROPRIATE BLANKS FOR EACH OF THE FOLLOWING
ITEMS
Yes No
1. n ❑ I am an ❑ elected or ❑ appointed ❑ officer or k employee of the City of Lansing
holding t e position of (c' spec j-ü'- in the 7 P Department.
❑ x 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
LII0 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. A I may derive income or benefit directly or indirectly from the bidding of,
negotiation o , solicitation of or entry into a contract with the City or from any 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(l) of the Code of Ordinances]
❑ ❑X 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(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:
i� Full-time ❑Part-time (less than 25 hours/wk) Unpaid
4. Name of the activity/business in question: 11 o�•LS- - a-1
5. Do you have ownership or interest in the activity/business? Yes . No
Updated Feb 2022
6. Does this activity/business conduct business with the City of Lansing? Yes No
If yes, please explain
7. Does the activity/busi11ess depend on you being an employee of the City of Lansing?
Yes No
If yes, please explain:
8. Who are the clients/customers of the activity/business?
9. Does this activity/business require your using equipment/facilities of the City of Lansing?
Yes No )(
If yes, please explain:
10. Does the activity/business use any advertisements or circulars that reference your employment
with the City of Lansing? Yes No
If yes, please attach copies.
11. Explain what you will be doing in the activity/business:
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12. Explain why you believe
a conflict may//may not exist with this activity/business: ' /
t.J f (I L' 7JJU a y e- - P i 2 !t •/ tt. /�1vL 7� G L L ulJ(L .S ( I V - / ct CJ
Cit -e( 6L-t, e * r i --GC - Ln.Ge o e o ��' r7 /c / te.�-i
dLt er NL T ?� o Jc�=ti. `i-s j^ h vi O1C
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13. 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? Yes > - No
If so, please describe:
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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.
Updated Feb 2022
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 Prlday of , 20Zy
Signa ure of Filer
STATE OF MICHIGAN
)ss.
COUNTY 0F \ '(L' k )
The foregoing instru nt was ackno I ged efore me this I day of .t,_
year), by 1Sac' l (Notary Signature)
• (Print Name)
Notary P�'f
ic, 1V\ County,
Acting in \r " 'i County,
My Commissio Expires: ..
CHRISTINA RAEDER
Notary Public-State of Michigan
County of Ingham ZD
My Commission Expires Elul 1}
Acting in the County of `
Updated Feb 2022