HomeMy WebLinkAboutKnight_Nancy - HARC 12.10.2015 COIMeeting Date la. 1� - 1
Agenda Item No. ���i-t
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STATE OF TEXAS )
CONFLICT OF INTEREST AFFIDAVIT
COUNTY OF WILLIAMSON
I, reside at
I am a member olt AAP -Z— (City Council or name of City board,
committee or commission)of the City of Georgetown, and I hereby make this affidavit and on my oath state the following:
"I, and/or a person or business entity whose interest is imputed to me under Chapter 171 of the Local Government Code and/or
Chapter 2.20 of the City of Georgetown Code of Ordinances, have a "substantial interest" in a business entity or in real property (as
defined by Chapter 171 of the Texas Local Government Code and Sec. 2.20.020.M of the City of Georgetown Code of Ordinances)
and/or an "economic interest" (as defined in Sec. 2.20.020.E of the City of Georgetown Code of Ordinances) in the matter that is
identified and described on the above -referenced agenda item.
"I have a conflict of interest in the above-referencedagenda matterfor the following reason(s): (checkallthat 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 of the voting stock or
shares of the business entity, or have an ownership of 10% or more of the fair market value ofthe business entity.
I or a person related to me in the first or second degree have an ownership of $15,000 or more of the fair market
value of the 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% of
my/his/her gross income for the previous year.
I or a person related to me in the first or second degree have an equitable or legal ownership or interest in real
property with a fav market value of $2,500 or more.
B. "Economic Interest"
I or a person or entity whose interest is imputed to me under Chapter 2.20 of the City of Georgetown Code of
Ordinances have a legal or equitable interest in real or personal property or a fiduciary obligation to such property or
contractual right in such property that is more than minimal or insignificant and would berecognized by reasonable
persons to have weight in deciding a case or an issue.
C. Piftr"
,For reasons other than those listed above, I have a conflict of interest (Please specify, e.g. Sec. 2.24.170 or other
_....,..._•ter- .- --' '�1-- t1 - -u - '- I -- - -� .- � - a .
"Upon filing of this affidavit with the recording secretary and/or the City Secretary, I affirm that I will abstain from all participation,
discussion and voting involving the matter identified in the above -referenced agenda item whatsoever.
Further, Affiant sayeth not."
Affiant's Signature:
Printed Name:
Date:
BEFORE ME, the undersigned authority, on this daypersonally appearedthe above-named person who on oath stated thatthe
facts hereinabove stated are true to the best of his/her knowledge or belief.
SWORN TO AND SUBSCRIBED before me on this _ day of 200-.
Notary Public in and for the State of Texas
County of Williamson
TRIS AFFIDAVIT SHALLBE BEPTwrrR THE OFFICIAL MINUTES OF THIS MEETING. rF AFFTANTHAS CRECKEDANY OF THEITEMS UNDER
SECTION "A" RELATING TO "SUBSTANTIAL INTEREST," A COPYOFTHIS AFFIDAVITMUSTALSOBESENTTOTHE CITY SECRETARYFORTBE
CITY OF GEORGETOWN.
Conflict of Interest Affidavit
Rev. 8/25/2004