HomeMy WebLinkAboutDustin White CITY OF JEFFERSONVILLE
er Y Off.
''� 812-285 6400 office
�ii4 N 812-285-6403 fax
Ath J •www.cityofjeff.net
�SO Jeffersonville City Hall
500 Quartermaster Court
Jeffersonville,Indiana 47130
ANNUAL CERTIFICATION OF ELECTED OFFICIAL TO THE EXECUTIVE OF THE CITY
OF JEFFERSONVILLE ON COMPLIANCE WITH MUNICIPAL NEPOTISM POLICY
INVOLVING DIRECT LINE SUPERVISION
I, Dustin White,the elected COMMON COUNCIL DISTRICT 1, 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.
Dated this /WI"
of Manua , 20Vj.
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(signature) _/ , (id‘i Pe
(printed name)
CITY OF JEFFERSONVILLE
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w.cityofjeff.net
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�SO� Jeffersonville City Hall
500 Quartermaster Court
Jeffersonville,Indiana 47130
CERTIFICATION OF ELECTED OFFICIAL TO THE EXECUTIVE OF THE "CITY OF
JEFFERSONVILLE ON COMPLIANCE WITH MUNICIPAL NEPOTISM POLICY
I, Dustin White, the elected COMMON COUNCIL DISTRICT 1 "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 I day of JAn iA4 U , 204
jTit2A
(Signature)
(Printed name)