disclosures: 0139756a38f318d448e03fccfec7637c1c3510a4c8cd2f1eb24a2746893776fe
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| 0139756a38f318d448e03fccfec7637c1c3510a4c8cd2f1eb24a2746893776fe | 2012/skarinKathleen6.7.19(2).pdf | 2012 | Kathleen Skarin | Middlesex Sheriff's Office | DISCLOSURE BY NON-ELECTED STATE EMPLOYEE OF FINANCIAL AND DETERMINATION AS REQUIRED BY BY APPOINTING G. L.c. 268A, AUTHORITYE § 6 ANTHICST COMMISSION STATE EMPLOYEE INFORMATION 2012 JUL 19 AM 9:47 Name: Kathleen Skarin Title or Position: Chief of Staff State Agency: Middlesex Sheriff's Office Agency Address: 400 Mystic Avenue Medford, MA 02155 Office Phone: 781-960-2800 Office E-mail: kgskarin@sdm.state.ma.us My duties require me to participate in a particular matter, and 1 may not participate because of a financial interest that 1 am disclosing here. I request a determination from my appointing authority about how 1 should proceed. PARTICULAR MATTER Particular matter E.g., a judicial or other proceeding, application, Decision about an increase in salary for at-will employees. submission, request for a ruling or other determination, contract, claim, controversy, charge, accusation, arrest, decision, determination, or finding. Your required participation in the particular matter: As the Chief of Staff, I am required to participate in matters relating to employee salaries. E.g., approval, disapproval, decision, recommendation, rendering advice, investigation, other. FINANCIAL INTEREST IN THE PARTICULAR MATTER Write an X by all that apply. __X_ I have a financial interest in the matter. My immediate family member has a financial interest in the matter. My business partner has a financial interest in the matter. I am an officer, director, trustee, partner or employee of a business organization, and the business organization has a financial interest in the matter. I am negotiating or have made an arrangement conceming future employment with a person or organization, and the person or organization has a financial interest in the matter. Financial interest Because I am an at-will employee, my salary will be impacted by the decision. It is likely in the matter that the increase in my salary will be less than $1,300. Employee signature: Date: Kathleng 6/28/2012 Skann DETERMINATION BY APPOINTING OFFICIAL APPOINTING AUTHORITY INFORMATION Name of Appointing Authority: Peter J. Koutoujian Title or Position: Middlesex Sheriff Agency/Department: Middlesex Sheriff's Office Agency Address: 400 Mystic Avenue Medford, MA 02155 Office Phone: 781-960-2800 Office E-mail Pjkoutoujian@sdm.state.ma.us DETERMINATION Determination by As appointing official, as required by G.L. C. 268A, § 6, I have reviewed the particular matter and the appointing authority: financial interest identified above by a state employee. Write an X I am assigning the particular matter to another employee, or by your selection. I am assuming responsibility for the particular matter, or I have determined that the financial interest is not so substantial as to be deemed likely to affect the integrity of the services which the Commonwealth may expect from the employee. Appointing Authority signature: R Date: 6/28/2012 Comment: Attach additional pages if necessary. File copy with: State Ethics Commission, One Ashburton Place, Room 619, Boston, MA 02108 Form Revised February, 2012 | 2012/skarinKathleen6.7.19(2).pdf |