HomeMy WebLinkAboutVicki Conlin CERTIFICATION OF ELECTED OFFICIAL TO THE EXECUTIVE "
OF THE "CITY OF
JEFFERSONVILLE ON COMPLIANCE WITH MUNICIPAL NEPOTISM POLICY
I, Jj (printed name), the elected City Clerk
insert elected office) of " City of Jeffersonville" certify that I have not violated the "City of
Jeffersonville" Contracting with a Unit Policy of IC 36 -1 -21, as amended or supplemented,
relating to contracts of my relatives' business interests with the " City of Jeffersonville" as
further described in Ordinance 2012 -OR -29
understand that Relative means my spouse, parent or stepparent, y p pparent, child or stepchild,
brother, sister, stepbrother, stepsister, niece, nephew, aunt, uncle, daughter -in -law or son -in-
law (including half - bloods and adopted children). I intend for this to be submitted to the Mayor
prior to the end of this calendar year
{ I hereby verify under the penalty of perjury that the foregoing statements are true.
Dated this / ? day of �(c /) e , 20 I a.
- Cal; - 4Lic-
(Signature)
C
(Printed name)
p u'