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AFFIDAVIT PROVIDING NOTICE OF POTENTIAL CONFLICT OF INTEREST <br /> THE STATE OF TEXAS § <br /> COUNTY OF HARRIS § <br /> CITY OF LA PORTE § <br /> I, (kuV. , a local public official of the City of La Porte, Texas (the City), make this <br /> affidavit and hereby on oath state the following: <br /> Action being contemplated by the City may have an effect on a business entity or real property in which I have an interest. <br /> Such interest may be a "substantial interest" as that term is defined in Chapter 171 of the Texas Local Government Code. The <br /> action being contemplated may have a special economic effect on the business entity or real property distinguishable from the <br /> effect on the public. <br /> The business entity or real property in which I have an interest is described as follows (name; address; or lot description): <br /> it y e,.,/a4 -.1 #,v Sv.v 17 / 2-Die/ 76- wr f4 (€, ( M'/''/.' f &A-eH ful. <br /> The nature and extent of my interest in the business entity or real property is herein described by stating that either I or a person <br /> related to me in the first degree of consanguinity (blood) or affinity (marriage), as determined by Chapter 573 of the Texas <br /> Government Code (check all that apply): <br /> Own 10 percent or more of the voting stock or shares of the business entity; <br /> Own 10 percent or more of the fair market value of the business entity; <br /> / Own $15,000 or more of the fair market value of the business entity; and/or <br /> V Received funds that exceed 10 percent of gross income for the previous year; <br /> Have an equitable or legal ownership in real property with a fair market value of at least $2,500 or more; <br /> Alternatively, even if I do not have a "substantial interest" as defined by Chapter 171 of the Texas Local Government Code, I <br /> am filin thisafida so as to avoid the appearance of impropriety. My interest may be described as follows: <br /> (' 14e/L /Or/5/7 9 y it 5 ht 1 / . <br /> Upon filing of this affidavit with the City Secretary, I affirm that I will abstain from any discussion, vote or decision involving <br /> this business entity or real property unless a majority of the members of the governmental entity of which I am a member is <br /> likewise required to file and has filed affidavits declaring similar interests on the same official action. <br /> Signed this the Z-7 day of S 4 e , 2011. <br /> Signs re f Affiatlt <br /> on igis' Z <br /> Title of Affiant <br /> BEFORE ME, the undersigned authority, on this day personally appeared [Atia_6 j666.t�''L and by oath stated <br /> that the facts hereinabove stated are true to the best of his /her knowledge or belief (/ <br /> SWORN to and subscribed before me on ti is the . t ay of , 2011. <br /> IIII <br /> a0 PATRI <br /> [���J 10 if , 1 / i : } N o ta ry public, State of Texas <br /> Notary Public in and it the St #' e of Te , , • . F 4 MY ComMission Expi <br /> L � Decombot 28.30119 es <br />