Laserfiche WebLink
CONFLICT OF INTEREST AFFIDAVIT <br />THE STATE OF TEXAS § <br />COUNTY OF HARRIS § <br />d <br />, -D1,119 Zt'v�� as a member of the City of LaPorte <br />c��j G , make this affidavit and hereby on oath state the following: i have a <br />substantial interest in a business entity or real property as defined in Chapter 171, Texas Local <br />Government Code, and a vote is to be taken or a decision is to be made that will have a special <br />economic effect on this business entity or real property. <br />The agenda item on , 20 // , affecting this business entity or real <br />property is: /A; ?ZD t? 1 ,j() <br />COMPLETE (A) OR (B): (A) The business entity is <br />(B) The real property is located at: <br />(name); or <br />I have a substantial interest for the following reasons: (check all which are applicable) <br />Ownership of 10% or more of the voting stock or shares of the business entity. <br />_ Ownership of 10% or more or $15,000 or more of the fair market value of the <br />/ business entity. <br />✓ Funds received from the business entity exceed 10% of gross income for the <br />previous year. <br />Real property is involved and I have an equitable or legal ownership of the <br />property with a fair market value of at least $2,500. <br />_ A relative of mine has a substantial interest in the business entity or real <br />property that would be affected by a decision of the public body of which I <br />am a member. <br />Upon filing of this affidavit with the City Secretary, I affirm that I will abstain from voting on any <br />decision involving this business entity or real property and from any further participation on this <br />matter by discussion or debate. <br />Sued this !`� day o Ck 20�. <br />Si a of fficial <br />THE STATE OF TEXAS § <br />COUNTY OF S § <br />r <br />Before me on this day personally appeared <br />known to me to be the person whose name is subscribed to the <br />foregoing ent and acknowledged to me that he/she executed the same for the purposes and <br />consideration therein expressed. / <br />Given under my hand and seat of office this./ 7 day o LG'A-20_Lj <br />ajzlt-"4'�z� <br />Notary Public in and f6l the Sta f Texas <br />