Laserfiche WebLink
CITY OF NORTH OLMSTED, OHIO <br />ETHICS COMMISSION <br />PUBLIC DISCLOSURE 'STATEMENT <br />(THIS STATFMENT MUST BE FILED WITH THE CHAIRMAN 0F THE ET'HICS COMMISSION NU La7ER) <br />(THAN APRIL 30 OF EACH yEAR FOR THE PERIUD JANUARy i- DFCEMBER 31 UF THE PRECEED) <br />(ING yEAR. TyPE OR PRINT CLEARLy. J <br />1. NAME (of person filing statement) <br />(Last) (First) <br />2. HOME ADDRESS <br />(Street) <br />3. EMPLOYER <br />City) (Zip Code) <br />(County) <br />(Street) (City) (Zip) <br />4. TITLE OF OFFICE/POSITION HELD: <br />5. DATE OF EMPLOYEMENT: 6. TERM OF OFFICE: <br />Middle) <br />PHONE <br />(A/C) (NumbPr) <br />7. NAMES AND RELATIONSHIP OF ANY FAMILY MEMBERS RESIDIIIG IN NORTH OLMSTED, OHIO: <br />Spouse <br />8. ALL NAMES UNDER WHICH YOU OR FAMILY MEMBERS DO BUSINESS. <br />A C <br />B D <br />9. DID YOU, OR TO YOUR KNOWLEDGE, DID ANY MEA4BER OF YOUR FAMILY AT ANY TIME IN <br />THE PAST YEAR EITHER DIRECTLY OR INDIRECTLY: (Indicate YES or NO) <br />A. Have any ownership interest in a supplier, client, contractor or business <br />firm which provided materials, supplies, equipment, property or services <br />of any kind to the City of North Olmsted? <br />B. Receive any compensation or other benefit of value in any form from a <br />supplier, client, contractor or business firm which provided material or <br />service of any kind to the City, or from any individual, firm or company <br />acting for or representing any supplier, contractor or business firm in <br />its dealings with the City of North Olmsted? <br />C. Serve as director, officer, trustee, employee,_or consultant of any company <br />which is a supplier, contractor, firm or business, or which acts for or <br />represents same, in its dealings with the City of North Olmsted? <br />D. Ilave any other affiliation with or financial or personal interest in a <br />supplier, contractor, consultant, or firm or company which provided mat- <br />erials, supplies, equipment, property or services of any kind to the City? <br />10. I.LST F,ACH SOURCE FROM WHICH YOU RECEIVED INCOME OF MURE IliAN $500 nL'RING THE <br />PRECF..EDING YEAR. ALSO, LIST EACH SOURCE OF INCOME OF MORE THAN $500 RECEIVED <br />BY A14Y OTHER PERSON FOR YOUR USE OR BENEFIT DURING THE PRECEEDING YEAR. FOR <br />EACH SOURCE OF INCOME LISTED, GIVE A BRIEF DESCRIPTION OF THE SERVICE PERFORMED. <br />ALTHOUGH YOU ARE REQUIRED TO LIST EACH SOURCE OF INCOME, YOU DO NOT HAVE TO <br />DISCLOSE ANY DOLLAR ($) AMOUNTS. - <br />A. Source: <br />Service Performed: <br />B. Source• <br />Service Performed: <br />C. Source: <br />Service Performed: <br />D. Source• <br />Service Performed: