HomeMy WebLinkAboutKayla Matos 2025 Financial DisclosureANNUAL STATEMENT OF FINANCIAL DISCLOSUR CITY OF ITHACA, NEW YORK
For Year: 202S
FILED
JAN 1 � 2025
Directions: This form must be completed in its entirety and submitted to the City Clerk by
February 1 st of each year, regardless of whether there have been any changes in your
financial information. Do not leave any spaces blank. Please indicate with a "N/A" only if the section is not applicable to you. If you require more space to provide information, please
attach additional sheets as necessary. Please consult with the City Attorney if you have any
questions regarding the completion of this form.
1.Please provide your name, address and position with the City of Ithaca.I Last Name
Residential Street
Address Number
I First Name
City
I Telephone
( L. u -=,. ) '-,.. °1 - 6-=f �9
I City Title
I Middle Initial S-
State Zip Code
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2.Please provide the name of your spouse, domestic partner, adult dependents, or adult
H/M. When used in this statement, "H/M" shall mean other household members who
reside with you and who intend to reside with you for the foreseeable future, and to whom
you are committed to mutual care and support. When used in this statement, DomesticPartner shall mean a person defined as a domestic partner pursuant to Chapter 215,
Article IV, of the City of Ithaca Municipal Code.
Spouse/Partner
Household
Member
Household
Member
Household
Member
Household
Member
Last Name First Name Middle Initial
XXXXXXXXXXXXXXXXXXXXX X
3. Financial lnterests:
A. Outside Employment
Please state any other employment, occupation, trade, business, office or business title or
profession held by you, your spouse, domestic partner, adult dependents, or H/M. Please
indicate whether such activity is licensed or regulated by any local agency.
B. Leave of Absence:
Are you on leave, paid or unpaid, frolgoy business or organization?
Yes: _ No: ..-'
lf yes, please identify the business or organization:
Occupation Name of
Business/Activity
Regulated By lf yes, nature of
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)
C. Associations and Orqanizations:
Please list any position that you hold in any proprietary or not-for-profit association,
organization, or political party as an officer, decision or policy maker, whether you received
monetary compensation or not. This includes honorary positions, self-appointed positions,
and positions held by virtue of your municipal position. This excludes general membership
and liaison roles where you have no decision or policy-making authority.
Organization Position Held Date(s) Held
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I
D. Real Estate:
List the location of all real estiate in or within five (5) miles of Tompkins County that is owned
in whole or in part by you, your spouse, domestic partner, adult dependents, or H/M.
Property Address Owned By
N\ /Ar
E. Business Connections:
Please indicate if you, your spouse, domestic partner, adult dependents, or H/M, are involved
in any profit-making or non-profit enterprise not previously disclosed, which has a business
connection, including contracts, with the City of lthaca:
(Please describe the principal activities and nature of the connection or contract with the city.)
Principle Activities Nature of Connection with the City
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F. DBA (Doing Business As):
Do you or anyone in your household have a current DBA, or ownership in a corporation that
has a DBA in Tompkins County?
Yes:
DBA Name(s)Owner
G. lnvestments and other assets:
You may exclude Mutual Funds and Blind Trusts from this section. Please itemize and
describe all investments (e.9. capital stock, bonds, lRA, trusts, etc.), which you, your spouse,
domestic partner, adult dependents, or H/M hold in any business, corporation, or partnership
as a majority owner or a significant interest (5% or more).
lnvestment (Please specifo as noted above)Owned ByWhom
N\ /+ci
No:
I
I
H. Loans:
List any outstanding loans payable or receivable over $1,000 involving people who live, work
or own prope(y in Tompkins county, excluding established financial institutions and family
members.
Purpose of Loan Lender or Recipient
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l. Gifts:
List any personal gifts and who gave them received by you, your spouse, domestic partner,
adult dependents, or H/M during the last 3 years from people who live, work or own property
in Tompkins County, of a value greater than $'1,000, other than from a relative:
Gift Given ToN/k
4. Other lnformation:
A. To the best of your knowledge are you or anyone in your household involved in any
organization or activity or holding any asset, excluding those listed above, that could be a
conflict of interest in performing the dylgs of your city position?Yes: No:
lf yes, please explain:
B. Do you have any holdings, assets,roperty held under any other name?
Yes: _ No:
Please explain:
5. Certification:
I certify that the responses herein are true and I understand that any willful misstatement
constitutes a violation of the City of lthaca Municipal Code and subjects me to penalties
provided in Section 55.12 of the City Code
f;l / r3l
Signature
05t04
01/19
Date
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Amount of Loan
Received from