Town of Mamaroneck, NY
Westchester County
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Table of Contents
Table of Contents
[Adopted 7-16-1986]
DISCLOSURE STATEMENT
pursuant to
Code of Ethics of the Town of Mamaroneck
(TO BE SIGNED BY EMPLOYEES LISTED
IN § 17-4 AND BY OTHERS REQUESTED
TO DO SO BY THE TOWN ADMINISTRATOR.)
I, _________________________________, holding the position of __________________, within the Town of Mamaroneck, hereby make this statement in accordance with the provisions of the Ethics Code of the Town of Mamaroneck.
1.
I do not nor does a member of my immediate family nor, to my knowledge, does a close business associate own any real property within the Town of Mamaroneck other than a family residence except as follows: (If property other than a family residence is owned, I am listing the owner, the location of any such property owned, whether it is improved or unimproved, and if it is unimproved, whether it is residential or commercial.)
2.
I list below the name and address of any partnership, corporation, joint venture or similar commercial enterprise which I or a member of my immediate family or, to my knowledge, a close business associate is a partner, officer, senior executive or shareholder, excluding any corporation, partnership or other business venture in which I, such family member or business associate have less than a five-percent interest:
3.
I am listing any other holding, association, position or business enterprise which I believe might in any way create a conflict of interest with regard to my duties for the Town:
............
Witness:
............