HomeMy WebLinkAboutBargainer_Tim - P&Z 03.01.2016 COICouncil/Board/C Sion: V% a— %/j�1.liLtOy-oV1,LYtiSnOln
Meeting Date: 3 / j /2p 6
Agenda Item Number:
STATE OF TEXAS
COUNTY OF WILLIAMSON CONFLICT OF INTEREST AFFIDAVIT
reside at 101 iJLLV�µtOu"� . I am member ofthe
(City Council, City Board, Committee or Commission) ofthe City ofGeorgetown, and I
hereby nuke this affidavit and on rry oath state the following:
"7, and/or a person or business entity whose interest is imputed to me under Chapter 171 ofthe Local Government Code and/or
Chapter 2.20 ofthe City ofGeorgetown Code ofOrdinances, have a "substantial interest" in a business entity or in real property (as
defined by Chapter 171 ofthe Texas Local Government Code and Sec. 2.20.020.M of the City ofGeorgetown Code ofOrdinances)
and/or an "economic interest' (as defined in Sec. 2.20.020.E ofthe City ofGeorgetown Code ofOrdinances) in the matter that is
identified and described on the above -referenced agenda item
"I have a conflict of interest in the above -referenced agenda matter for the following reason(s): (check all that are applicable).
A. "Substantial Interest"
I or a person related to me in the first or second degree have an ownership of 10% or more ofthe voting stock or shares ofthe
business entity
I or a person related to me in the first or second degree have an ownership of 10% or more of the fair market value ofthe
business entity or have an ownership of$15,000 or more ofthe fair market value ofthe business entity.
I or a person related to me in the first or second degree received funds from the business entity in excess of 10% ofmy/his/her
gross income for the previous year.
I or a person related to me in the fust or second degree have an equitable or legal ownership or interest in real property with a
fair market value of$2,500 or more.
B. 'Economic Interest'
� I or a person or entity whose interest is irn puted to me under Chapter 2.20 ofthe City of Georgetown Code ofOrdinances have
a legal or equitable interest in real or personal property or a fiduciary obligation to such property or contractual right in such
j -- property that is more than mvtinml or insignificant and would be recogniad by reasonable persons to have weight in deciding a
\_ case or an issue. A C ity official may not take any official action that the official knows is likely to affect the substantial
econo interests of..
the City official's family member or a business entity for which the city official serves as an officer, director, or in a
policy-making position,
❑ a person or business entity from whom, within the past 12 months, the City official or official's spouse, directly or
indirectly, has solicited, received and not rejected or accepted an officer ofemployment, or is engaged in negotiations
pertaining to business opportunities.
C. "Other"
For reasons other thanthose listed above, I have a conflict ofanterest (Please specify, e.g. Sec. 2.24.170 or other reason):
"Upon filing ofthis affidavit wHhthe recording secretary and/or the City Secretary, I affirm that I will abstain from allparticipation,
discussion and voting involving the matter identified in the above -referenced agenda itemwhatsoever.
Further, Affiant sayeth not"
Printed Name: TNA %C1r4alAw
Affiants Signature:
Date:
BEFORE ME, the undersigned authority, on this day personally appeared the above -mined person who on oath stated that the facts
hereinabove stated are true to the best ofhis/her knowledge yr belief -p
SWORN TO AND SUBSCRIBED before me on this I day of A4a-�t . ,zot& 16
STEPHANIE M I C K A N MCNICKIE
F"'5N�V,
No ub ' binand for the Steras
Notary Public. State of Texas a4'My Commission Expires Countyol'illiamson
Mnrch 23, 2016 1
THISAFFIDA OF THIS MEETING. IFAFFIANTHAS CHECKEDANYOF THE ITEMS UNDER
tSECTION"A"RELATING TO"SUBSTANTIAL INTEREST, -A COPYOF THISAFFIDA VIT MUSTALSO BE SENT TOTI& CITYSECRETARYFOR THE CITYOF
�' GEORGETOWN. Conflict of Interest Affidavit Revised 7.19.1011 ❑