HomeMy WebLinkAbout05/23/2023 MIN A It STENTION AFFIDAVIT
THE STATE OF TEXAS §
COUNTY OF JEFFERS N §
, as a member of the Bea u 1�11D 11+ (City Council, Commission, or
Ic�y �or �le,l�Board) shake this affidavit and hereby on oath state the following: I, and/or a'person or-
persons related to
me, have a substantial interest in a business entity that would be peculiarly affected by a vote or decision
of the (City Council, Commission, or Board) as those terms are defined in V.T.C.A.,
Local Government Code, § 171.002.
The business entity is: evuernalemi
C
(Name) 3 c 5• a3 •,a3
i)01/1671 L lL7 I
(Address)
("I," or name of relative and relationship) have/has a substantial interest in this
business entity for the following reasons: (check all of which are applicable.)
Ownership of 10 percent or more of the voting stock or shares of the business entity.
Ownership of either 10 percent or more or $15,000 or more of the fair market value of the
business entity.
Funds received from the business entity exceed 10 percent of(my, her, his) gross
income for the previous year.
Real property is involved, and (I, he, she) have an interest which is an equitable
or legal ownership with a fair market value of at least $2,500.
A relative of mine, within the first or second degree by blood or marriage, has a substantial
interest in the business entity or property that would be affected by a decision of the public
body of which I am a member.
Upon filing of this affidavit with the City Clerk, I affirm that I will abstain from voting on any decision involving
this business entity
and
from any further;participation on this matter whatsoever.
Signed this the oC`J day l/�
of '' , 20
S' re of Official
(A) d
Title
BEFORE ME, the undersigned authority, on this day personally appeared 1 JlAp61_,
and on oath stated that the facts hereinabove stated are true to the best of his/ e knowledge or belief.
SWORN to and subscribed before me o this the R3r day of 2003.
ro'''.' TINA G. BROUSSARD — /11/4 '
6,Ao--0400.4
;_�: ��;Notary Public,State of Texas Notary Public in an for he Sate of Texas
Comm.Expires 01-12-2027
'%,,;;;,.``. Notary ID 11435119