HomeMy WebLinkAboutJeremy Neff 2025 Conflict of Interest (BPW approved 1/15/25) FILED
( '' UNIFORM CONFLICT OF INTEREST DISCLOSURE STATEMENT JAN 17 2025
•1) Stela Form 54266(RZ!&15)/Form 236
. STATE BOARD OF ACCOUNTS
CLERK LARK Cl... 4#'1'CUIT
Indiana Code 36-44.1 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 unemanclpated 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
35-44.1-1-4 in its entirety.
1. Name and Address of Public Servant Submitting Statement:
2. Title or Position With Governmental Entity: Supervisor- Motor Vehilce (Street Dept)
3. a. Governmental Entity: City of Jeffersonville
b. County: Clark
4. This statement is 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
b.✓ 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 Contractor(s)or Vendor(s): Jeremy Neff
6. Description(s) of Contract(s) or Purchase(s) (Describe the kind of contract involved, and the
effective date and term of the contract or purchase if reasonably determinable. Dates required if 4(a)
is selected above. if"dependent"is involved,provide dependent's name and relationship.):
Provide Chaplain Services to firefighters end family members Involved in fatalities.minor!Merles.
funerals,anv stress related incidents.
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7. Description 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 contract(s) or purchase(s); if reasonably determinable, state the approximate dollar
value of such profit or benefit.):
Chaplain services.Annual canlract on tie
(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
en elected public servant or the board of trustees of a state-supported college or university.):
I (We)being the Board of Public Works of
(Title of Officer or Name of Governing Body)
City of Jeffersonville and having the power to appoint
(Name of Governmental Entity)
the above na d ubli servant to the public position to which he or she holds, hereby approve the
participation a ap ointed d' closing public servant in the above described contract(s) or
purchase(s) I hich s id public ervant has a conflict of interest as defined in Indiana Code 35-
44.1-1-4; ho er, thi approval oes not waive any objection to any conflict prohibited by statute,
rule, or regul a is not to b construed as a conse t to any illegal act.
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Elected Official Office
9. Effective Dates (Conflict of interest statements must be submitted to the governmental entity prior
to final action on the contract or purchase.):
t
Date Submitted(month,day,year) Date of Action on Contract or Purchase(month,day,year)
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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 perjury,the truth and completeness of
the statements made above,and that I am the above named pu lic servant.
Signed: >—
(Signature of. bblic Servant)
Date: 01/15/2025
(month, day, year)
Printed Name: Jeremy Neff
(Please print legibly.)
Email Address: Jeremyneff424@gmail.com
Within fifteen (15) 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 https://gateway.ifionline.oro/sboa 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.
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