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Home My WebLink About2019 COUNCIL CITY OF JEFFERSONVILLE GST Y O,p W�itwIt•A ? 812-285-6400 office W 812-285-6403 fax A•„ www.cityofjeff.net RSONJeffersonville City Hall 500 Quartermaster Court Jeffersonville,Indiana 47130 ANNUAL CERTIFICATION OF ELECTED OFFICIAL TO THE EXECUTIVE OF THE CITY OF JEFFERSONVILLE ON COMPLIANCE WITH MUNICIPAL NEPOTISM POLICY INVOLVING DIRECT LINE SUPERVISION I, CALLIE JAHN , the elected COMMON COUNCIL THIRD DISTRICT,of Jeffersonville certify that I have not violated the City of Jeffersonville Nepotism Policy in hiring and supervision of IC 36-1-20.2, as amended or supplemented, relating to my relatives' employment with the City of Jeffersonville as further described in 2012-OR-29 document adopting AN ORDINANCE ADOPTING CONFLICT OF INTERESTAND NEPOTISM LAW POLICY. 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. Da •d t''s o , 20 I t (.ignature) 410 (printed name) An equal opportunity employer. CITY OF JEFFERSONVILLE /TY O,, W ` 1- ?, 812-285-6400 office c.. - Wan 812-285-6403 fax T www.cityofjeff.net � Rs��J Jeffersonville City Hall 500 Quartermaster Court Jeffersonville,Indiana 47130 CERTIFICATION OF ELECTED OFFICIAL TO THE EXECUTIVE OF THE "CITY OF JEFFERSONVILLE ON COMPLIANCE WITH MUNICIPAL NEPOTISM POLICY I, CALLIE JAHN, the elected COMMON COUNCIL THIRD DISTRICT 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 2012-OR-29 document adopting AN ORDINANCE ADOPTING CONFLICT OF INTERESTAND NEPOTISM LAW POLICY. 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 , say of ...)(41,11/11/t14/ , 201. p-04) (Sign re) C gd_W L " X 1h (Printed name) An equal opportunity employer. CITY OF JEFFERSONVILLE 812-285-6400 GST Y O,c Jeffersonville City Hall geet!, 500 Quartermaster Court 4 Jeffersonville,Indiana 47130 SFR oN4/ ANNUAL CERTIFICATION OF ELECTED OFFICIAL TO THE EXECUTIVE OF THE CITY OF JEFFERSONVILLE ON COMPLIANCE WITH MUNICIPAL NEPOTISM POLICY INVOLVING DIRECT LINE SUPERVISION I, DUSTIN WHITE, the elected COMMON COUNCIL FIRST DISTRICT,ofJeffersonville certify that I have not violated the City of Jeffersonville Nepotism Policy in hiring and supervision of IC 36-1-20.2, as amended or supplemented, relating to my relatives' employment with the City ofJeffersonville as further described in 2012-OR-29 document adopting AN ORDINANCE ADOPTING CONFLICT OF INTERESTAND NEPOTISM LAW POLICY. 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. Date his 411. day of94i..yucLe.„4/ 2019 • cam& (signature) (printed name) An equal opportunity employer. CITY OF JEFFERSONVILLE GST Y c-fi a W prii' w 812-285-6400 office LI.� 10"-1 812-285-6403 fax •i� 0�\,'; www.cityofjeff.net SON Jeffersonville City Hall 500 Quartermaster Court Jeffersonville,Indiana 47130 CERTIFICATION OF ELECTED OFFICIAL TO THE EXECUTIVE OF THE "CITY OF JEFFERSONVILLE ON COMPLIANCE WITH MUNICIPAL NEPOTISM POLICY I, DUSTIN WHITE, the elected COMMON COUNCIL FIRST DISTRICT 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 2012-OR-29 document adopting AN ORDINANCE ADOPTING CONFLICT OF INTERESTAND NEPOTISM LAW POLICY. 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 enalty of perjury that the foregoing statements are true. Datthis 4411day of , 20a. Ii( 64 I) (td..t.k (Signature) / // 00S71in /. WGl/ Te (Printed name) An equal opportunity employer. CITY OF JEFFERSONVILLE GST uuY O,t : jIVi`' N 812-285-6400 office t� A - W 812-285-6403 fax Twww.cityofjeff.net " &SO— ' Jeffersonville City Hall 500 Quartermaster Court Jeffersonville,Indiana 47130 ANNUAL CERTIFICATION OF ELECTED OFFICIAL TO THE EXECUTIVE OF THE CITY OF JEFFERSONVILLE ON COMPLIANCE WITH MUNICIPAL NEPOTISM POLICY INVOLVING DIRECT LINE SUPERVISION I, MATT OWEN ,the elected COMMON COUNCIL AT LARGE ,of Jeffersonville certify that I have not violated the City of Jeffersonville Nepotism Policy in hiring and supervision of IC 36-1-20.2, as amended or supplemented, relating to my relatives' employment with the City of Jeffersonville as further described in 2012-OR-29 document adopting AN ORDINANCE ADOPTING CONFLICT OF INTERESTAND NEPOTISM LAW POLICY. 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 7 day of D--,-,,in , 2016k . Lidodor7i (sign. . - � � C . D1,de (printed name) An equal opportunity employer. CITY OF JEFFERSONVILLE 812-285-6400 ,(6-,‘"Tr Ot� , Jeffersonville City Hall a j10'6_ `" N i 500 Quartermaster Court _ . Jeffersonville,Indiana 47130 W <‘#<• ,,,,, �F CERTIFICATION OF ELECTED OFFICIAL TO THE EXECUTIVE OF THE "CITY OF JEFFERSONVILLE ON COMPLIANCE WITH MUNICIPAL NEPOTISM POLICY I, MATT OWEN,the elected COMMON COUNCIL AT LARGE 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 2012-OR-29 document adopting AN ORDINANCE ADOPTING CONFLICT OF INTERESTAND NEPOTISM LAW POLICY. 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 7 day of Jan un , 20161. (Sign. . - ) C . Owes (Printed name) An equal opportunity employer. CITY OF JEFFERSONVILLE 812-285-6400 GST Y O.r Jeffersonville City Hall d'eN 500 Quartermaster Court • Jeffersonville,Indiana 47130 FRsot CERTIFICATION OF ELECTED OFFICIAL TO THE EXECUTIVE OF THE "CITY OF JEFFERSONVILLE ON COMPLIANCE WITH MUNICIPAL NEPOTISM POLICY I, RON ELLIS, the elected COMMON COUNCIL AT LARGE 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 2012-OR-29 document adopting AN ORDINANCE ADOPTING CONFLICT OF INTERESTAND NEPOTISM LAW POLICY. 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 7 day of LAMA-AY , 201 f. koktet-el 112/14 (Signature) &.)4-Jd G s (Printed name) An equal opportunity employer. CITY OF JEFFERSONVILLE rGy?Y Off. : illIrl`' ?, 812-285-6400 office t_� - 41 812-285-6403 fax K4,,,_. T • *. www.cityofjeff.net RSON4 Jeffersonville City Hall 500 Quartermaster Court Jeffersonville,Indiana 47130 ANNUAL CERTIFICATION OF ELECTED OFFICIAL TO THE EXECUTIVE OF THE CITY OF JEFFERSONVILLE ON COMPLIANCE WITH MUNICIPAL NEPOTISM POLICY INVOLVING DIRECT LINE SUPERVISION I, RON ELLIS, the elected COMMON COUNCIL AT LARGE ,of Jeffersonville certify that I have not violated the City of Jeffersonville Nepotism Policy in hiring and supervision of IC 36-1-20.2, as amended or supplemented, relating to my relatives' employment with the City of Jeffersonville as further described in 2012-OR-29 document adopting AN ORDINANCE ADOPTING CONFLICT OF INTERESTAND NEPOTISM LAW POLICY. 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 1 day of (,vuA-A Y , 20 /' iderk,e0 v, , (signature) /c7ci J,4id C. ki-40-5 (printed name) An equal opportunity employer. CITY OF JEFFERSONVILLE 812-285-6400 GST Y O� Jeffersonville City Hall N500 Quartermaster Court Jeffersonville,Indiana 47130 I �. �� 2%•%1 \RSO CERTIFICATION OF ELECTED OFFICIAL TO THE EXECUTIVE OF THE "CITY OF JEFFERSONVILLE ON COMPLIANCE WITH MUNICIPAL NEPOTISM POLICY I, NATHAN SAMEUL, the elected COMMON COUNCIL AT LARGE 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 2012-OR-29 document adopting AN ORDINANCE ADOPTING CONFLICT OF INTERESTAND NEPOTISM LAW POLICY. 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 thi 7 day of TZA1U2A'--7 , 20L2. /ee/ 4. (S gna ur ) (P inted name) An equal opportunity employer. CITY OF JEFFERSONVILLE TY O . uv W� GSQ�O' N 812-285-6400 office t_ 01, 11"-iii 812-285-6403 fax ilk �� I`� www.cityofjeff.net -RSONJeffersonville City Hall 500 Quartermaster Court Jeffersonville,Indiana 47130 ANNUAL CERTIFICATION OF ELECTED OFFICIAL TO THE EXECUTIVE OF THE CITY OF JEFFERSONVILLE ON COMPLIANCE WITH MUNICIPAL NEPOTISM POLICY INVOLVING DIRECT LINE SUPERVISION I, NATHAN SAMEUL, the elected COMMON COUNCIL AT LARGE ,of Jeffersonville certify that I have not violated the City of Jeffersonville Nepotism Policy in hiring and supervision of IC 36-1-20.2, as amended or supplemented, relating to my relatives' employment with the City of Jeffersonville as further described in 2012-OR-29 document adopting AN ORDINANCE ADOPTING CONFLICT OF INTERESTAND NEPOTISM LAW POLICY. 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 t is 7 7 d y of J 2 vi Li 2v--7 , 20 i ( ga ,I I ) 7) l�'\2✓1 2 iid�1Ve (p inted name) An equal opportunity employer. CITY OF JEFFERSONVILLE .-,;.=-1-z 6,--- , 812-285-6400 office L_ - - W 812-285-6403 fax CA A\ V www.cityofjeff.net FRSON� Jeffersonville City Hall 500 Quartermaster Court Jeffersonville,Indiana 47130 ANNUAL CERTIFICATION OF ELECTED OFFICIAL TO THE EXECUTIVE OF THE CITY OF JEFFERSONVILLE ON COMPLIANCE WITH MUNICIPAL NEPOTISM POLICY INVOLVING DIRECT LINE SUPERVISION I, LISA GILL,the elected COMMON COUNCIL FIFTH DISTRICT,of Jeffersonville certify that I have not violated the City of Jeffersonville Nepotism Policy in hiring and supervision of IC 36-1-20.2, as amended or supplemented, relating to my relatives' employment with the City of Jeffersonville as further described in 2012-OR-29 document adopting AN ORDINANCE ADOPTING CONFLICT OF INTERESTAND NEPOTISM LAW POLICY. 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 i7 day of , 20 /9 signator ) ✓ �" (printed name) An equal opportunity employer. CITY OF JEFFERSONVILLE 0 0 812-285-6400 office L. W 812-285-6403 fax www.cityofjeff.net FRSOV Jeffersonville City Hall 500 Quartermaster Court Jeffersonville,Indiana 47130 CERTIFICATION OF ELECTED OFFICIAL TO THE EXECUTIVE OF THE "CITY OF JEFFERSONVILLE ON COMPLIANCE WITH MUNICIPAL NEPOTISM POLICY I, LISA GILL, the elected COMMON COUNCIL FIFTH DISTRICT 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 2012-OR-29 document adopting AN ORDINANCE ADOPTING CONFLICT OF INTERESTAND NEPOTISM LAW POLICY. 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 ,-J day of r , 20/ /4/eA-1' igna ure) 71 (Printed name) An equal opportunity employer. CITY OF JEFFERSONVILLE G0T Y OA. .1u W� "��%\?, 812-285-6400 office t_ - - W 812-285-6403 fax � www.cityofjeff.net ?SO�J Jeffersonville City Hall 500 Quartermaster Court Jeffersonville,Indiana 47130 CERTIFICATION OF ELECTED OFFICIAL TO THE EXECUTIVE OF THE "CITY OF JEFFERSONVILLE ON COMPLIANCE WITH MUNICIPAL NEPOTISM POLICY I, SCOTT HAWKINS, the elected COMMON COUNCIL SIXTH DISTRICT 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 2012-OR-29 document adopting AN ORDINANCE ADOPTING CONFLICT OF INTERESTAND NEPOTISM LAW POLICY. 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 i day of r� L ed 201. r (Signature) 4_,, k (Printed name) An equal opportunity employer. CITY OF JEFFERSONVILLE GST Y OA. o •'�wy., °,, 812-285-6400 office t_ - MO>W 812-285-6403 fax T\ Ay/ v www.cityofjeff.net FRsoN�� Jeffersonville City Hail 500 Quartermaster Court Jeffersonville,Indiana 47130 ANNUAL CERTIFICATION OF ELECTED OFFICIAL TO THE EXECUTIVE OF THE CITY OF JEFFERSONVILLE ON COMPLIANCE WITH MUNICIPAL NEPOTISM POLICY INVOLVING DIRECT LINE SUPERVISION I, SCOTT HAWKINS,the elected COMMON COUNCIL SIXTH DISTRICT,of Jeffersonville certify that I have not violated the City of Jeffersonville Nepotism Policy in hiring and supervision of IC 36-1-20.2, as amended or supplemented, relating to my relatives' employment with the City of Jeffersonville as further described in 2012-OR-29 document adopting AN ORDINANCE ADOPTING CONFLICT OF INTERESTAND NEPOTISM LAW POLICY. 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 nalty of perjury that the foregoing statements are true. Date this 7pyofc �-t'=---tr , 20cid z---\ (signature) (printed name) An equal opportunity employer. CITY OF JEFFERSONVILLE 812-285-6400 G, O Jeffersonville City Hall W,/ w500 Quartermaster Court _ W Jeffersonville,Indiana 47130 � V T�RSoNJ� ANNUAL CERTIFICATION OF ELECTED OFFICIAL TO THE EXECUTIVE OF THE CITY OF JEFFERSONVILLE ON COMPLIANCE WITH MUNICIPAL NEPOTISM POLICY INVOLVING DIRECT LINE SUPERVISION I, ED ZASTAWNY,the elected COMMON COUNCIL SECOND DISTRICT,of Jeffersonville certify that I have not violated the City of Jeffersonville Nepotism Policy in hiring and supervision of IC 36-1-20.2, as amended or supplemented, relating to my relatives'employment with the City of Jeffersonville as further described in 2012-OR-29 document adopting AN ORDINANCE ADOPTING CONFLICT OF INTERESTAND NEPOTISM LAW POLICY. 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. Dat j; day of , 2019 (signature) ZS/lc:kW Al (printed name) An equal opportunity employer. CITY OF JEFFERSONVILLE GST Y Off. uu W '=;�//i;= ? 812-285-6400 office W 812-285-6403 fax SA www.cityofjeff.net T FRSO� Jeffersonville City Hall 500 Quartermaster Court Jeffersonville,Indiana 47130 CERTIFICATION OF ELECTED OFFICIAL TO THE EXECUTIVE OF THE "CITY OF JEFFERSONVILLE ON COMPLIANCE WITH MUNICIPAL NEPOTISM POLICY I, ED ZASTAWNY, the elected COMMON COUNCIL SECOND DISTRICT 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 2012-OR-29 document adopting AN ORDINANCE ADOPTING CONFLICT OF INTERESTAND NEPOTISM LAW POLICY. 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 7 day ofJctni-c.A— , 201 (Signature) .CILkoci Z457‘c-,J (Printed name) An equal opportunity employer. CITY OF JEFFERSONVILLE GST Y O,r W��i 1i�-..°0b. N 812-285-6400 office t.. - - W 812-285-6403 fax T v www.cityofjeff.net J\ TRsOttJeffersonville City Hall 500 Quartermaster Court Jeffersonville,Indiana 47130 ANNUAL CERTIFICATION OF ELECTED OFFICIAL TO THE EXECUTIVE OF THE CITY OF JEFFERSONVILLE ON COMPLIANCE WITH MUNICIPAL NEPOTISM POLICY INVOLVING DIRECT LINE SUPERVISION I, SCOTTIE MAPLES, the elected COMMON COUNCIL FOURTH DISTRICT,of Jeffersonville certify that I have not violated the City of Jeffersonville Nepotism Policy in hiring and supervision of IC 36-1- 20.2, as amended or supplemented, relating to my relatives' employment with the City of Jeffersonville as further described in 2012-OR-29 document adopting AN ORDINANCE ADOPTING CONFLICT OF INTERESTAND NEPOTISM LAW POLICY. 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 . „day of (ivit`Qrr , 20 /`1. , �- i (signa ure) - , 3r 01L1 1401.5 J_ (printed name) An equal opportunity employer. CITY OF JEFFERSONVILLE GST Y Off. 10110 ° 812-285-6400 office ttaW 812-285-6403 fax T www.cityofjeff.net v �FRS0tl Jeffersonville City Hall 500 Quartermaster Court Jeffersonville,Indiana 47130 CERTIFICATION OF ELECTED OFFICIAL TO THE EXECUTIVE OF THE "CITY OF JEFFERSONVILLE ON COMPLIANCE WITH MUNICIPAL NEPOTISM POLICY I, SCOTTIE MAPLES, the elected COMMON COUNCIL FOURTH DISTRICT 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 2012-OR-29 document adopting AN ORDINANCE ADOPTING CONFLICT OF INTERESTAND NEPOTISM LAW POLICY. 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 4- day of -T- 64nU , 20 c' A .144Vt-'41 (Signature) s - illiI (Printed name) An equal opportunity employer.