Grosse Pointe Shores Improvement Foundation
Conflict of Interest Disclosure Form

First and Last Name

Do you have a business or family relationship with the any other trustee or key city employee? (Family members to be disclosed are: spouse, child, sibling, parent or grandparent of the foregoing.) If yes, please describe the relationship below.

Yes

Have you or any of your family members had any business transactions with the GPSIF, either directly or indirectly, through an organization with which you or a family member is a board member, trustee, director or owner? If yes, describe the transaction.

Yes

Are you or any of your family members an official, board member or employee of the Village of Grosse Pointe Shores? If yes, state your title in the box below.

Yes

If you answered yes to any question, please elaborate.

I hereby certify that the information set forth on this form is true and complete to the best of my knowledge. I understand that as a trustee, I must complete a disclosure form annually. I also understand that it is my ongoing responsibility to report any conflicts of interest if and when they arise if they have not already been reported on this Disclosure Form.

Select the date:

Grosse Pointe Shores Improvement Foundation Conflict of Interest Disclosure Form

Grosse Pointe Shores Improvement Foundation
Conflict of Interest Disclosure Form