HomeMy WebLinkAboutTheresa Treadway 3/4/26 , FILED
MAR 04 2026
' UNIFORM CONFLICT OF INTEREST DISCLOSURE STATEMENT
• 7' State Form 54266(R2/6-15)1 Form236
F ' 4 STATE BOARD OF ACCOUNTS •
4. CLERK LARK CI CUIT COURTS
Indiana Code 35.44.1-1-4
interest in or derives a profit from
A public servant who knowingly or intentionally egovernementai entity served by the public servant
cpr mite or purchase connected with an actionnbu public servant has a pecuniary interest in a contract or
commits conflict of tract a Class D F11 result
ul Pu.
.inCom so If the oft or publ case servant or atdependen of the publ clservantCe"Dependent"increase
means any
income 11 net worth th p31-9-2-2)
of the following:seg: the spouse of aemancipated servant;
nd less than eighteen seen (18) years(asf age; and any individual
m'8 public servant who is unemancipated
is provided during a year by the public servant.
-` :more than one-half(1/2)of whose support
The foregoing consists only of excerpts from IC 35-44.1-1-4. Care should be taken to review IC
35�44.1-i-0 in its entirety. ` '�/' rs phi i
1.'• Name and Add
ress of Public Servant Submitting Statement 11���t ► u
aut.\
b.
- -- - ) - 1e�EL 1t2�-
2.e,Title or Position With Governmental Entity: .
3.` a. Governmental Entity:
b. County: t "� 1.1--
4'•; This statement is submitted(check one): cific contract or
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a._ as a'single transaction"disclosure statement, as to my financial interest inat Pbe made by the
purchase connected with the governmental entity which I serve, proposed
governmental entity with or from a particular contractor or vendor;or
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t
ed with
. .b._ as an ses of disclosure
statement,
entity as serve,which are financial smade on anongoing basis with or
acts or
purchases of the g
from particular contractors or vendors. 'N l l;�
or Vendor(s): i I } j�C � `
5. Name(s)of Contractor(s)
.�,
of Contract(s) or Purchase(s) (Describe the kind of contract involved, and the
8: Describe date
determinable. Dates required if 4(a)
•effective and term of the contract or purchase If reasonably
is selected above. If"dependent"Is Involved,provide dependent's name and relationship.)'
tf ‘a iL ell, ' l l ' • i1 tt
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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,
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the above contract(s) or purchase(s); if reasonably determinable, state the approximate dollar
value of such profit or benefit.):
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is i1I+r< itWt r hL J)n ( j
l Y11l(0�
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..,� . 1 )5()-t- riTe e
• _ (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 state-supported college or university.):
I(We)being the
'k �C. o of
(Title of Off sr or Name of Governing Body)
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� �yd nJ , CA and having the power to appoint
• (Name of Governmental Entity)
the above named public servant to the public position to which he or she holds, hereby approve the
participation to the appointed disclosing public servant in the above described contract(s) or
purchase(s) in which said public servant has a conflict of interest as defined in Indiana Code 35-
44.1-1-4; however, this approval does not waive any objection to any conflict prohibited by statute,
rule,or regulation and is not to be construed as a consent to any illegal act.
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Elected Official
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g, • fictive Dates (Conflict of interest statements must be submitted to the governmental entity prior
to jIna!action on t e contract or purchase.):
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bate Submitted (month,day,year) Date of Action on Contract or Purchase(month,day,year)
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,110. 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 public servant.
Signed: �.)f. Ailfi >. . .
(Signature of Public Servant) j
Date: rviiirwton,„
Z 5) t
(month, day,year)
fh
Printed Name: Y LY&" ' tL Lt^J'
•a '= (Please print legibly.)
Email Address: /I1) / %«fte II C �
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 h a/fc�aa y.ifioIndianae.0r Gove Government ich is
Center
the preferred method of filing, or by mailing it to the State Boardtf A
.C�cu t Court f the coun 302 West ty where the governmental entity on Street, Room E418, took finall action on the contract or purchase.Indiana, 46204-2765 and the Clerk of the
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