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Office of the City Clerk 175 South Arizona Avenue Chandler, AZ 85225 480-782-2181 CONFLICT OF INTEREST DISCLOSURE MEMORANDUM To: Dana DeLong, City Clerk From: [Print Name of Member and Name of Board, Commission, or Committee] Re: Conflict of Interest Disclosure Pursuant to A.R.S. §§38-501 to 38-511 Disclosure of Interest A conflict of interest exists if you or a relative has a pecuniary or proprietary interest, directly or indirectly, in this matter. A “relative” includes your spouse; children and grandchildren; parents and grandparents; brothers and sisters, as well as their spouses; and your spouse’s parents, brother, sisters and children. 1. Identify the matter or decision under consideration by the public body, case investigation, or other matter in which you or your relative may have a “substantial interest” under A.R.S. §§38-501 to 38-511. 2. Describe the “substantial interest” referred to above. Statement of Disqualification To avoid any possible conflict of interest under A.R.S. §§38-501 to 38-511, I will refrain from participating in any manner in the matter identified above. ____________________________________ __________________ Signature of Public Officer or Employee Date File with the City Clerk