HomeMy WebLinkAboutED ZASTAWNY 812-285-6400
G�?Y
— , Jeffersonville City Hall
W N 500 Quartermaster Court
* Jeffersonville,Indiana 47130
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ANNUAL CERTIFICATION OF ELECTED OFFICIAL TO THE EXECUTIVE OF THE CITY
OF JEFFERSONVILLE ON COMPLIANCE WITH MUNICIPAL NEPOTISM POLICY
INVOLVING DIRECT LINE SUPERVISION
I, EDWARD ZASTAWNY,the elected COMMON COUNCIL SECOND DISTRICT ,of Jeffersonville
certify that I have not violated the City of Jeffersonville Nepotism Policy in hiring and supervision of IC
36-1-20.2, as amended or supplemented, relating to my relatives' employment with the City of
Jeffersonville as further described in 2012-OR-29 document adopting AN ORDINANCE ADOPTING
CONFLICT OF INTERESTAND NEPOTISM LAW POLICY.
I understand that Relative means my spouse, parent or stepparent, 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.
Date s 3 day of .? , 20
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( ignature)
n
T (Jk.z��
(printed name)
An equal opportunity employer.
812-285-6400
GST Y O�
— , Jeffersonville City Hall
h o 500 Quartermaster Court
* N Jeffersonville,Indiana 47130
'– W
TFRso���
CERTIFICATION OF ELECTED OFFICIAL TO THE EXECUTIVE OF THE "CITY OF
JEFFERSONVILLE ON COMPLIANCE WITH MUNICIPAL NEPOTISM POLICY
I, EDWARD ZASTAWNY, the elected COMMON COUNCIL SECOND DISTRICT 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 2012-OR-29 document
adopting AN ORDINANCE ADOPTING CONFLICT OF INTERESTAND NEPOTISM LAW
POLICY.
I understand that Relative means my spouse, parent or stepparent, 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 .�G� ��ti , 200
(Signature)
A Zus �wN
(Printed name)
An equal opportunity employer.