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CONFLICT OF INTEREST AFFIDAVIT <br />THE STATE OF TEXAS § <br />COUNTY OF HARRIS § <br />` 1 i <br />C C-- as a member of the City of La Porte l <br />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 />_ <br />The agenda itn � �k 1 , 20 � � , <br />, ` affecting this business entity or real <br />e o \ � <br />property is: ��\1 <br />COMPLETE (A) OR (B): <br />(A) The business entity is (—\ C N,�,>\� 1 ��'632' name); or <br />(B) The real property is located at: <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 />V 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 />Singed this day of <br />Signature of Official <br />THE STATE OF TEXAS § <br />COUNTY OF HARRIS § <br />Bef e me S�'�,' ' ' 6 Lt�j on this day personally appeared <br />IITA'o(-Lknown to me to be the person whose name is subscribed to the <br />foregoing instrument and acknowledged to me that he/she executed the same for the purposes and <br />consideration therein expressed. <br />Given under my hand and seal of office this 4. day of A f , 20_LL. <br />(SEAL) F , <br />ht�mL �1--/ a ; Q"i YVONNE GARRISON <br />No Public in and for the State of Texas r MY COMMISSION EXPIRES <br />October 28, 2013 <br />