Fillable Potential Conflict of Interest Notice (City of Minneapolis)

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Potential Conflict of Interest Notice (City of Minneapolis)

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City of Minneapolis Employees
Potential Conflict of Interest Notice
Minneapolis Code Chapter 15 Ethics in Government
Instructions
• This notice must be completed and distributed as indicated below prior to taking
an action or making a decision
that would substantially affect the employee’s financial interest or those of an associated business or involves the
employee’s relatives or affiliated organizations. See M.C.O. §§ 15.40(b) & 15.40(c)(4)
• 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
Employee ____
_____________________________________
Distribute to:
_
__ Immediate Supervisor
_
__ Department Head
_
__ City Clerk, 350 South 5th Street, Room 304, Minneapolis 55415
Action or Decision Date of Action or Decision _________________
Description or action or decision
Type(s) of conflict: check all that apply Origin(s) of conflict: check all that apply
_
__ Source of compensation; earned income ___ Self
_
__ Loan ___ Spouse or Domestic Partner
_
__ Securities ___ Dependent
_
__ Real Property ___ Other Related Person
_
__ Real Property ___ Associated business
__ Pari-mutual horse racing ___ Associated business of Spouse,
_
__ Affiliation with an organization or entity Domestic Partner or Dependent
_
__ Other
Description of Potential Conflict of Interest
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Potential Conflict of Interest Notice (City of Minneapolis)

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Completed 23 January 2021

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