HomeMy WebLinkAboutMarcus Renn Filed 1/18/24 lii
JOIN 18 2c2k
CLERKr<C? CJITCOJfir$t� 'i UNIFORM COdFLCT OF INTEREST DISCLOSURE STATEMENT
i „ SIAM Form MS 10-181rFano128
STATE.SOAKS OF ACCOUNTS
Indiana Code 35-44.1-1.4
A public servant who knowingly or intentionally has a pecuniary Interest in or derives a profit from
a contract or purchase connected with an action by the governmental entity soared by the public servant
commits conflict of interest,a Class D Felony. A public servant has a pecuniary Interest In a contract or
purchase If the contract or purchase will result or is Intended to result In an ascertainable Increase in the
Income or net worth of the public servant or a dependent of the public servant. "Depondenr means arty
of the following: the spouse of a public servant;a child,stepchild,or adoptee(as defined In IC 31-4t-2-a)
of a public servant who Is unemanctpated end less then eighteen(18 years of age;and any Individual
more than one-half(1/2)of whose support Is provided during a year by the public servant.
The foregoing consists only of oxcorpta from IC 35-44.1-1-4. Care should be taken to review IC
35-44.1-1-4 In its entirety.
1. @lame and Address of Publics Servant Submitting Statement: Le 4 �a",1 \/J
2. 'Title or Poulton With Severn,nontai Entity: ?-•' ice r 6-'6
3. a. Governmental Entity: 7-lg.-Cr gi C ,5 114e4"ie "nrei
b. County: ��-eft Q1ir_
4. This statement is submitted(choc4 one): .
a, as a"single transaction"disclosure statement,as to my financial interest in a specific contract or
" purchase connected with the governmental entity which I serve, proposed to be made by the
governmental entity with or from a particular contractor or vendor,or
b._ as an"annuar disclosure statement,as to my!Mandel interest connected with any contracts or
purchases of the governmental entity which I serve,which are made en an ongoing basis with or
from particular contractors or vendors. icr,
5. timings)of Contractors)or Vendor(s): /54.Ac.rt f5404 l .4..-,0,1 jre,e ''I C
6. Doscriptiun(s) of Contract(s) or Purchase(s) (Describe the kind of contract Involved, and the
effective dale and tune of the contract or purchase if reasonably a'etwrnlnvbie. Dates required If 4(a)
is selected above. If"dependent"is Involved,provide dependenVs name and relationship.):
D.-'s, R9N ref 'L-,t s'-► 14(IL r �d i_L
Pogo I of 3
7. Doeeriptlon of My Financial Interest (Describe in what manner the public servant or"depen-
dent"expects to derive a profit or financial benefit from,or otherwise has a pecuniary Interest in,
the above coninact(s) or puatirase(s); ff reasonably determinable, slate the approximate dollar
value of such profd or benefit.):
�M vo xc 2 f�j Lemi -..d' J.*'Y --
�U&7e 1 �aTr-7-7' 'C.X"-V a F ��fip r-
iuwrez7 J .
(Attach extra pages if additional space is needed.)
8. Approval of Appointing Officer or Body(To be completed if the public servant was appointed by
an elected public servant or the board of trustees of a staler-supported collage or university.):
t(We)being the of
mile of Officer or f+feme o1 Governing Body)
and having the power to appoint
(Name of is vorrrmenlal
the above named p c co sent to a public position to which he or she holds,hereby approve the
participation t ppointed dt using public servant in the above described contract(s) or
purcha s) said public 'ant has a conflict of interest as defined In Indiana CCoodd�e 35-
44.1-1-4; v fa approval as not waive any objection to any conflict prohibited by statute,
rule,or ropu tL d is not to be netrtred as a consent a Illegal act.
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Elected Official Ogee
0. Effective Dates(Conflict of interest statements mast be submitted to the governmental entity prior
to final action on the contact orpur .):
I- ihtim
Dale Submitted(month,day,mug Deco of on/Contract or tor enandi,day.fir)
Paz,2 o13
10. Affirmation of Public Servant: This disclosure was submitted to the governmental entity and
accepted by the governmental entity in a public meeting of the governmental entity prior to final
action on the contract or purchase. I affirm,under penalty of pey1ury,the truth and compieten@
of
the statements made above,end that I era the above named public aervt,t.
StgneQ;/�� r
alum o Ic e
Date: ti o C1• a c L1
Printed Name: iV
(Roost)print /
Email Address:dh AA tat/4tJ 7'J)
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Within fifteen(15)days after final action on the contract or purchase.copies of this statement must be
tiled with the State Board of Accounts by uploading it hem fig sr fig; :y,lUonllne.oru(siga Gaf/which is
the preferred method of filing,or by melQng It to tho Stets Board of •..:, into,Indiana Commment Center
South,302 West Washington Shot,Room So$18,Indlanapotla,Indiana,40204-2765 and the Clerk of the
Circuit Court ditto county where the governmental entity took final action on tho oordmct or purchase.
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