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CONFLICT OF I nTREST AFFmAVTT <br />THE STATE OF TEXAS I <br />COUNTY OF HARRIS § <br />tJ 1 L as a member of the City of La Porte i A �J <br />(LC -I make this affidavit and hereby on oath state the Mowing: I have a <br />substantial interest in a business entity or real property as defined in Chapter 171, Texas Local <br />Governmena: 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 busimess entity or real property. <br />The agenda item on r t , 20 D , affecting this business entity or real <br />ply is: \ Fl� R -e S '� <br />COMPLETE (A) OR (B): (A) The business entity is `, ('CiC' iJt\% (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 cE ity. <br />Funds received from the business entity exceed 10% of gross income for the <br />pm -v year. <br />Real property is involved and I have an equitable or legal ownership of the <br />property with, a fair market valm of at least $2,500. <br />A relative of mine has a substantial interest m the business entity or real <br />property that would be affected by a da; mn 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 �k + day of T , 20 � lei <br />Signature of Official <br />THE STATE OF TEXAS $ <br />COUNTY OF HARRIS ¢ <br />Before me ,) a 0 - j i 16 t� on this day persomlly appy <br />` Ir,____ T;0 '61 a ck known to me to be the person whose name is mbscnbed to the <br />foregomg instrument and acknowledged to me that he/she executed the same for the purposes and <br />consideration therein expressed. f <br />Given under my hand and seal of office this day of .20 - <br />(SEAL) 20(SEA-) - jy <br />N lic in and Yor the Stale of Teras <br />MARTHA SILLETT <br />My COMNUbn Expires <br />•,,,___,,. Augm 91, 2013 <br />