HomeMy WebLinkAboutNATHAN SAMUEL 812-285-6400
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— , Jeffersonville City Hall
q N 500 Quartermaster Court
* Jeffersonville,Indiana 47130
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CERTIFICATION OF ELECTED OFFICIAL TO THE EXECUTIVE OF THE "CITY OF
JEFFERSONVILLE ON COMPLIANCE WITH MUNICIPAL NEPOTISM POLICY
I, NATHAN SAMUEL, the elected COMMON COUNCIL AT-LARGE 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 3' day of 2 V1 L_z- 20 -.7
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(Printed name)
An equal opportunity employer.
812-285-6400
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Jeffersonville City Hall
0 500 Quartermaster Court
* Jeffersonville,Indiana 47130
'— W
FRsoN
ANNUAL CERTIFICATION OF ELECTED OFFICIAL TO THE EXECUTIVE OF THE CITY
OF JEFFERSONVILLE ON COMPLIANCE WITH MUNICIPAL NEPOTISM POLICY
INVOLVING DIRECT LINE SUPERVISION
I, NATHAN SAMUEL,the elected COMMON COUNCIL AT LARGE ,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.
f L
Dated this 3 day of 201
(si nat r )
7 'ZA S 24ALt6/
(prin ed name)
An equal opportunity employer.