City of Minneapolis Local Officials
Potential Conflict of Interest Notice
Minneapolis Code Chapter 15 Ethics in Government
Instructions
• Local officials shall disclose a potential conflict of interest to the other individuals on the agency, authority or
instrumentality
as soon as the local official becomes aware of the potential conflict.
• If a local official becomes aware of a conflict during a meeting, the local official shall immediately disclose the
conflict of interest orally.
• This notice must be completed and distributed to the other individuals on the agency, authority, board,
commission or instrumentality. This notice must also be filed with the City Clerk. Copies must also be sent to
the Council President, the Mayor and any department head whose jurisdiction or agency could be affected.
• All information on this report is public information.
• Address questions to the City’s Ethics Officer in the City’s Attorney Office at 612-673-3230 or
EthicsOfficer@minneapolismn.gov
Local Official ___________________
______________________
Action or Decision Date of Action or Decision _________________
Description or action or decision
Origin(s) of conflict: check
all that apply
___ Self
___ Spouse or Domestic Partner
___ Dependent
___ Other Related Person
___ Associated business
___ Associated business of Spouse,
Domestic Partner or Dependent
Type(s) of conflict: check all that apply
___ Source of compensation; earned income
___ Loan
___ Securities
___ Real Property
___ Real Property
___ Pari-mutual horse racing
___ Affiliation with an organization or entity
___ Other
Description of Potential Conflict of Interest
Send to: 1) Other individuals on agency, authority, instrumentality, board or commission 2) Mayor 3) City Council
Members 4) City Clerk 5) Department Head whose jurisdiction or agency could be affected
