|
RECUSAL (PLEASE PRINT)
|
I, ____________________________________ ,
(full name)
holding the position of _________________________________________________ ,
 (job title and name of board/commission/agency/dept)
hereby under oath depose and say:
1. A matter involving ____________________________________ is presently
before the ____________________________________.
(name of board/commission/agency/dept)
2. I have the following interest in the matter noted in paragraph 1 above:
________________________________________________________________
________________________________________________________________
________________________________________________________________.
3. {Please select one of the following}
( ) A. In compliance with RIGL §36-14-6(1), I hereby recuse myself from participating in the discussion of or taking official action relating to said matter.
( ) B. In compliance with RIGL §36-14-6(1), I hereby state that despite the interest described above, I believe I am able to participate fairly, objectively and in the public interest regarding said matter for the following reasons:
________________________________________________________________
________________________________________________________________.
¤ ¤ ¤
Signed under the penalties of perjury this ___ day of ____________, 200__.
__________________________________________________________
Signature
|
|
|
|
