HomeMy WebLinkAboutSchroeder_Josh - P&Z 05.03.2016 COICounci/Board/Cosion:
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Meeting DatV ��
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Agenda Item Number-
STATE OF TEXAS
COUNTY OF / /CONFLICT OFINTEREST AFFIDAVIT l pp L+1 �6 I�f 5,� �i . I am a member ofthe
- I, _ S �S� J � ��f� ,reside at �
(SL— (City Council, City Board, Committee or Commission) ofthe City ofGeorgetown, and I
hereby make this affidavit and on my oath state the following:
% and/or a person or business entity whose interests 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 ofthe City ofGeorgetown Code ofOrdinances)
and/or an "economic interest" (as defined in Sec. 2.20.020.E ofthe City ofGeorgetown Code of Ordinances) in the matter that is
identified and described on the above -referenced agenda item
'4 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 fast or second degree have an ownership of 10% or more ofthe voting stock or shares ofthe
business entity
I or a person related to ire in the fast or second degree have an ownership of 10% or more ofthe 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 fast or second degree received fiords from the business entity in excess of 10% ofmy/ltis/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
fair 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 ofthe City ofGeorgetown Code ofOrdinances have
a legal or equitable interest in real or personal property or a fiduciary obligation to such property or contractual right um such
property that is more than minimal or insignificant and would be recognized by reasonable persons to have weight in deciding a
C) case or an issue. A City official may not take any official action that the official knows is likely to affect the substantial
economic interests of
❑ the City official's family trernber 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 ofernployrnent, or is engaged in negotiations
pertaining to business opportunities.
C. "Other"
_J_,__4or rea,�ons other thanthose listed above, I have a conflict of interest (Please specify, e.g. Sec. 2.24.170 or other reason):
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"Upon Sling ofthis affidavit with the recording secretary and/or the City Secretary, I affamthat I will abstain from all participation,
discussion and voting involving the matter identified in the above -referenced agenda item whatsoever.
Further, Affiantsayethn "oro"� STEPHANIE MCNICKLE c 1
s3%+' •"%V. NOTMYPUBLICSTATE OF_cyA� dNarre: �4�5�-
? :'• COMM. EXP. 03-23.2020 s S-�n/����p�
te-
NOTARY ID 12845015.1
BEFORE ME, the undersigned authority, on this day personally appeared the above-named person who on oath stated that the facts
hereinabove stated are true to the best ofhWher knowledge or belief
�.
SWORN TO AND SUBSCRB3EDbefore meonthis ILdayof,4 . an,' / l�/1!.'c/1 r
—'—/T�
NotaryPublk in/Ian d for the State ofTexas
County of W illiammon
TIBSAFFIDAVIT SHALL BE KEPT WMH THE OFFICL9L MINUTES OF THIS MEETING. IFAFFMNT HASCHECKEDANYOFTI&ITEMS UNDER
SECTION"A" RELATING TO "SUBSTANTIAL INTEREST, "A COPYOF THISAFFIDAVIT MUSTALSO BE SENT TO THE CHYSECRETARYFOR THE CITYOF
GEORGETOWN. Conflict oflntemstAflidma Revised 7.19.1011❑