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Description(s) of Contract(s) or Purchase(s) <br />6. (Describe the kind of contract involved, and <br />the effective date and term of the contract or purchase if reasonably determinable. Dates required <br />if 4(a) is selected above. If "dependent" is involved, provide dependent's name and relationship): <br />______________________________________________________________________________ <br />______________________________________________________________________________ <br />______________________________________________________________________________ <br /> <br /> <br />Description of My Financial Interest <br />7. (Describe in what manner the public servant or <br />"dependent" expects to derive a profit or financial benefit from, or otherwise has a pecuniary <br />interest in, the above contract(s) or purchase(s); if reasonably determinable, state the <br />approximate dollar value of such profit or benefit.): <br />______________________________________________________________________________ <br />______________________________________________________________________________ <br />______________________________________________________________________________ <br />______________________________________________________________________________ <br />______________________________________________________________________________ <br />______________________________________________________________________________ <br />(Attach extra pages if additional space is needed) <br /> <br />Approval of Appointing Officer or Body <br />8. (To be completed if the public servant was <br />appointed by an elected public servant or the board of trustees of a state-supported college or <br />university): <br /> <br />I (We) being the ____________________________________________________________ of <br /> (Title of Officer or Name of Governing Body) <br />_______________________________________________ and having the power to appoint <br /> (Name of Governmental Entity) <br /> <br />the above named public servant to the public position to which he or she holds, hereby approve <br />the participation to the appointed disclosing public servant in the above described contract(s) or <br />purchase(s) in which said public servant has a conflict of interest as defined in Indiana Code 35- <br />44-1-3; however, this approval does not waive any objection to any conflict prohibited by statute, <br />rule, or regulation and is not to be construed as a consent to any illegal act. <br /> <br />_____________________________________ ______________________________________ <br />_____________________________________ ______________________________________ <br />_____________________________________ ______________________________________ <br /> Elected Official Office <br /> <br />Effective Dates <br />9. (Conflict of interest statements must be submitted to the governmental entity <br />prior to final action on the contract or purchase.): <br />_____________________________________ ______________________________________ <br /> Date Submitted Date of Action on Contract or Purchase <br /> <br /> 17 <br /> <br />