HomeMy WebLinkAboutSchroeder_Josh - Council 03.23.2021 COISTATE OF TEXAS
COUNTY OF WILLIAMSON
Meeting Type and Date O
Agenda Item No.
CONFLICT OF INTEREST AFFIDAVIT
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Agenda Item Topic ty��Nlu� #
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I, NV-_t reside at 6
I am a member of the (City Council name of City board, committee or
commission) of the City ofGeoi%etown, and I herebj 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 ofthe
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 -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 of the voting stock or shares of the business entity
or have an ownership of 10% or more of the fair market value of the 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 fair market
value of $2,500 or more.
B. "Economic Interest"
1 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 be recognized by reasonable persons to have weight in deciding a case or an issue.
C. "Other"
1/ F0� reasons other than those listed above, I have a conflict of interest (Please specify, e.g. Sec. 2.24.170 or other reason)
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"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 Naime:
Date: ?— k
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 thisz6ay of�ck-, 204f�.
,it, -"ROBYN LOUISE DENSMORE
My Notary 1251357056 Notary Pu ,lie in and for the State of Texas
Etas AM 15. 2022 County of Williamson
THI I10WMTr7rrRTTT7VTTF'CHE OFFICIAL MINUTES OF THIS MEETING. IF AFFIANT HAS CHECKED ANY OF THE
ITEMS UNDER SECTION "A" RELATING TO "SUBSTANTIAL INTEREST," A COPY OF THIS AFFIDAVIT MUST ALSO BE SENT TO
THE CITY SECRETARY FOR THE CITY OF GEORGETOWN.
Conflict of Interest Affidavit
Rev. 01/2021