HomeMy WebLinkAboutDykensDarren Affidavit Disclosure 2018 S
CITY OF LANSING AFFIDAVIT OF DISCLOSURE
cHtGP
TO: CITY CLERK DATE: b " ' r�
I M Zvi '/ 5 make the following disclosure under oath:
(Name)
PLEASE CHECK THE BOX AND FILL IN THE APPROPRIATE BLANKS FOR EACH OF THE
FOLLOWING ITEMS
o Yes o No
1 •r p I am an o elected or o appointed j -officer or o employee of the City of Lansing holding the
position of -?its the Department
❑ 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
❑Aam 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 ❑p I may derive income or benefit directly or indirectly from the bidding of, negotiation of,
solicitation of or entry into a contract with the City or from and City action detailed below.
(Charter 5-505.1)
❑ W 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(1) 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]
o i-- 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:
Full-time o Part-time (less than 25 hours/wk.) o Unpaid
6/10
4 PLEASE DESCRIBE IN DETAIL YOUR REASON(S)FOR SUBMITTING THIS DISCLOSURE
AND EXPLAIN WHY YOU THINKA CONFLICT MAY/MAYNOT EXIST.
R" "Pt gyrc'c 5'z c , ,, AXe - f pia c
eV6,(-Ts PE,L c2 T, M C/ 3/09 L 1 - -' v�F �v7� T
11 f ri D ry j7 Tt [t, ir5, G 'c3'5 `c)a4i (/
UDC ,GO/t' 1 5 icc5 (7 ,
M' ,t'o' L i 5 ,26o// Z T(
%/i'i2oy�4'
pLAyr.�S A )AC,
6 y0P F/l Z,r c11 LF ��� .�o/�kS o6y (491.liOvt J
6OOOTy 5t #W/ 4-f 'y 7-q ,q-A)0 r4L36
�T 5 1 HAVE 5Pak-E W TT - !f i1 - f-fE Ffi95 7bud
f1T' HE /1/tS (0CT EJi'lD -3S(iX-S c.-t'
7 Z /x T PMT ory t)vo/ t.L)c, ,4.0 y .-rs 5 P0L 5o, Ev
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 / day of '
20
State of Michigan,County of t-_-
Subscribed and sworn to before me this I o gnega of "\ 20 16
Y
Krt
Notary9übJic1or Deputy Clerk
e Cou ty Michigan
My Commission Expires: -7 o
GREGORY ALLEN POLVERENTO
NOTARY PUBLIC,STATE OF MI
COUNTY OF CLINTON
MY COMMISSION EXPIRES Feb 7,2024 7/10
ACTING IN COUNTY OFD� ,h ,`
ATTACHMENT TO AFFIDAVIT OF DISCLOSURE
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
Lr42GT
1OD %
• Are you self-employed? 'lts
• Who is your employer, if applicable?
• What are the things you actually do in the business? PL'y ,4y 52L
f6 fl TS
• Who are your clients and who receives your goods or services? Y L.
GUNT jqA(--r y N l S pJ 4 rL'-/p,&G.CC.
• How and where are your services performed? 5r4 r6- of
W/O c/6 H C.�J. 'rL'4Gr it-7
• How often do you do outside work? mot,Uvs w YA,r E t &c 1TS
8/10
,Does your business or employer contract with the City?
• In performing your business or outside employment, do you use any City facilities or
equipment?
v If so, describe:
• Is any of your business or employment conducted in the City? Nf If so, describe:
�� SS�c3tLiT�/ iT 2 & P. a- pt^_u�4T& .T5 ZO 1tfit' C�Tt( 6,•
U..1 c cl f)-f cCJ6J
AA.ua�
Does your business adverti�ement or circulars, if any, contain any reference to the City or
your City employment? /"0
• 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? If so, please
describe: /0 D
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.
9/10
Q
LANSING POLICE DEPARTMENT
120 West Michigan Avenue
Lansing, MI 48933
Phone: (517)483.4600 (TDDNoice)
Fax: (517) 377-0162 •
Virg Bernero, Mayor Interim Chief Mike Yankowski
MAR 102017
To: City Clerk
From: Captain Cherie Ballor
Re: Supplemental Employment
Date: March 10, 2017
Attached is a Supplemental Employment Affidavit of Disclosure for Officer Darren Dykens.
Please present to the Ethics Board and forward me a copy of the Ethics Board determination.
Thank you for your attention to this matter. Any questions please feel free to contact me.
Yaptain Cherie Ballor
Lansing Police Department
Central Services
(517) 483-4647
"POLICE& COMMUNITY PARTNERSHIPS FOR PROGRESS&EXCELLENCE"
"Equal Opportunity Employer"
tiptiN S 1�G �_
CITY OF LANSING AFFIDAVIT..OF DISCLOSURE
l
CHIGP
TO: CITY CLERK DATE: b /g
I- /� �ZEr l7��Glr'�f make the following disclosure under oath:
(Name)
PLEASE CHECK THE BOX AND FILL IN THE APPROPRIATE BLANKS FOR EACH OF THE
FOLLOWING ITEMS
o Yes o No
1 • ,❑ I am an o elected or o appointed officer or o employee of the City of Lansing holding the
position of 4n the Department
❑-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
❑Ayam 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 ❑p I may derive income or benefit directly or indirectly from the bidding of, negotiation of,
solicitation of or entry into a contract with the City or from and City action detailed below.
(Charter 5-505.1)
o 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]
❑ - 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]
o S- 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:
ter Full-time o Part-time (less than 25 hours/wk.) o Unpaid
6/10
4 PLEASE DESCRIBE IN DETAIL YOUR REASON(S)FOR SUBMITTING THIS DISCLOSURE
AND EXPLAIN WHY YOU THINKA CONFLICT MAY/MAYNOT EXIST.
Z r„Jl c c ,�� r�7 4y2T, A iit- sl C if P/lyr /'Pti l C
�/yl�•yT S ' - c S '�LL lc- yjJ/r ,13v?r iv
vin ri rc '' ODf-y S A4TL EvF.�S, CGvdS `v ei�� L�
,4 tYo 7z; : r✓2T L j 5g ,9L6-° oGL
5 'C/ 6(5 j 5 i E -7, l L✓LLG EDGE
,7v i'°1( of 5. T'Z w &- r off. 5 %Pil ° /
47 6 ycP F/21',00 r2r € ,God ( GI�Dr�litl
(O k)T y 5 MCA.<r,06 PEP✓-t 4TK--E.- 4-f dl. b IgPv T y /�4y D
DT 5 `T f-f AVE 5PakC t rru 1-I1/k H H' 5 %o1D
fri F 1HE /P5 i-DcT //�I D -35ti f c.-�'Iu - 1t r £L- 4-'( s.
bo .ydT P/- 'l-J D,t wai .ue- ,4.y y C75 S sPd.Uc Cp
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 /8 day of
20 1 .
State of Michigan,County of 4
Subscribed and sworn to before me this I 0 gnega Yof J 20 0 6
� KK
Notay9tibJicIor Deputy Clerk
Cou ty Michigan
My Commission Expires: 1 7 ¢oz
GREGORY ALLEN POLVERENTO
NOTARY PUBLIC,STATE OF MI
COUNTY OF CLINTON
MY COMMISSION EXPIRES Feb 7,2024
ACTING IN COUNTY OF fl .
ATTACHMENT TO AFFIDAVIT OF DISCLOSURE
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
• Are you self-employed?
• Who is your employer, if applicable?
• What are the things you actually do in the business? pLF V "''t o 5I L
FOB- E LrATS
• Who are your clients and who receives your goods or services? Li c
GyNTc/k v € u S pi2ItJv�r6/p - C.rc.
• How and where are your services performed? 5T4 rt c5F rt4l�l/Z c 4N
%l/toc'6(-f CJ rL'4cr iii;
• How often do you do outside work? Ot'��s w F1it �vFJ7TS
8/1O
Does your business or employer contract with the City? �d
• In performing your business or outside employment, do you use any City facilities or
equipment?
v If so, describe:
• Is any of your business or employment conducted in the City? 65 If so, describe:
6tf, bZ- P�.,uI T&, & -u rc XO -I (fC C,tTt(
U.1
pry�ue�,• Does your business advertAi�ement or circulars, if any, contain any reference to the City or
your City employment? /''d
• 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? If so, please
describe: ,(J9
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.
9/10