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HomeMy WebLinkAboutJeremy Neff Filed 1/18/24 ' I -ki_.v i'Mac -r ry JAN 18 2U2'i ;'!' UNIFORM CONFLICT OF IP TER ST DISCLOSURE STAIRS P n�T C �. 1• `iii' 8aareFarm84288tR2/8-imiFmmnu w RK CI CCUIT COURTS STATE BOARD OF ACCOUNTS Indiana Code 3t1-44.1-1-4 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 served 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. "Dependent"means any of the following: the spouse of a public servant;a child,stepchild,or adoptee(as defined In IC 31-9-2-2) of a public servant who Is unemancipated and less than 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 excerpts from IC 35.44.1-1-4. Care should be taken to review IC 3.5-44.1-1.4 In Its entirety. 1. Name and A1ddreeo of Public Servant Submitting Statement:Jeremy Neff 2. Title or Position With Governmental Entity: Chaplian with Jeffersonville Fire Dept 3. a. Governmental Entity: City of Jeflersonvllte b. County: Clark 4. This statement in submitted(check 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 be' as an"annual"disclosure statement,as to my financial interest connected with any contracts or purchases of the governmental entity which I serve,which are made on an ongoing basis with or from particular contractors or vendors. 5. Name(s)of Contractors)or Vendor(s): Jeremy Neff fi. Description(s) of Contract(e) or Paerchase(e) (Dosoibe the kind of contract Involved, and the effective data and term of the contract or purchase if reasonably detennlnablo. Dates requited ff 4(a) is selected above. If dependent"Is Involved,provide dependent's name and relationship.): Proeltf,flinphen oerdnss In Pett[d+lue dnd Panty morn6ars tmwovad La feietsoe,minor Nuryfaaa,tantunts,are,ukMd Imddadfe, Pagmlof3 7. Description of My Financial interest (Describe In whet 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 contrac t(s) or purchase(s);If reasonably determinable, state the appro,dmalo dollar value ofsuch profit or benefit): auwlWI far cluirtatil&W I — (Attach extra pages if additional space is needed.) S. Approval of Appointing Officer or Body(To be completed f the college ant was sr�)wed by an elected public servant or the board of(ruatoes of a state-supported I(We)being the Board of Public Works of (Title al Officer or Name of Governing Body) City of Jeffersonville and having the power to appoint (Name of Governmental Entity) the above named p c servant .9 the public position to which he or she holds,hereby approve the participation to th ppointed 'isciosing public servant in the above described contract(s) or purchase(s) In wh h said publi9 servant has a conflict of Interest as defined In Indiana Code 35- 44.1-1-4;h•. :` ,t is approve does not waive any objection to any conflict prohibited by statute, rule,or retails 0•• _ Is not to ,;�con_struue-d—a-s a consent any Illegal act. 11U - i ---- Elected Official Office S. Effective Dates(Conflict of Interest statements must be submitted to the governmental entity prior to final action on the contract orpurchase.): f LO Date Submitted(math,day,y 9 Date of Ad ion on cx or Phase(maitb,day,yam) Page 2M3 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 peury,the truth and completeness of the statements made above,and that I am the above named public servant. Signed: ( ' al f public Servant) Date: .3cac‘ a0a1r (month, day,year) Printed Name: Jeremy Neff (Please print legibly.) Email Address: Jeremyneff424©gmail.com Within fifteen (16) days after final action on the contract or purchase, copies of this statement must be filed with the State Board of Accounts by uploading it here httos:llaateway.ilioniine.orotsboa coil which Is the preferred method of filing,or by mailing it to the State Board of Accounts, Indiana Government Center South,302 West Washington Street, Room E418, Indianapolis,Indiana,46204-2765 and the Clerk of the Circuit Court of the county where the governmental entity took final action on the contract or purchase. Pogo 3 of 3