HomeMy WebLinkAboutNepotism Statement-Vicki Conlin •
CERTIFICATION OF ELECTED OFFICIAL TO THE EXECUTIVE OF THE "CITY OF
JEFFERSONVILLE ON COMPLIANCE WITH MUNICIPAL NEPOTISM POLICY
I 1/' % 4Z (printed name), the elected City Clerk
insert elected office) of " 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 Ordinance 2012 - OR - 29
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 / 9 day of _5(..(/) e , 201?..
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(Signature)
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(Printed name)