HomeMy WebLinkAboutSchroeder_Josh - Council 11.24.2020 COI141 1HR
GE0RGETOWN
TEXAS
CONFLICT OF INTEREST AFFIDAVIT
CHAPTER 2.20
a2r►tc' 1 Board / Commiss 'on:� _
Meeting Date:
r
Agenda Item Number:
STATE OF TEXAS
COUNTY OF WILLIAMSON §
I, C> �> "\ � "V ' /-r, c o'er � , reside at � � � U( S
_ I am a member of the
J r1 C ounci , oard, Committee, or Commis n) of the City of Georgetown, and I hereby
make this affidavit and on my oath state the followin
"I have a conflict of interest pursuant to Chapter 2.20 in the above -referenced agenda matter for the following reason(s):
(check all that are applicable)
The item involves my outside employer or the outside employer of a member of my family or household
The item involves a business entity I or my family owns five percent more of a voting stock or share or five thousand
dollars or more of FMV.
The item involves a business entity from which I receive or my family member receives more than 10% of our gross income
in the previous year.
The item involves real property in which I or a family member or member of my household have an equitable interest or legal
ownership.
The item involves a person or business entity from whom I or a member of my family solicited or received and did not reject
a good faith offer ofemploym nt within the past six months. JJ
M )ce -p tr f0 .�5e„b �1.0 � hLi+Y1r
"I further attest that if I have
not aCso s�mitted aChapter 171 Conflili+ t f Interest Affidavit that I do not have a conflict of interest
under Chapter 171 of the Local Government Code."
"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." Printed Name: r
Affiant's Signature:
Date: f Z
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 of his/her knowledge or belief.
SWORN TO AND SUBSCRIBED before me on this It -day of k &,r zzZU
=ze
E NSI«IDRE
Notary Public in and for the State of Texas
T5657056
'G E>pkftApd 15, 2022 County of Williamson
A COPY OF THIS AFFIDA VIT MUST BE SUBMITTED TO THE GEORGETOWN CITY SECRETARY
(00010527 / v / SMASSON / LEGAL / FORMS / 04/16/20191