Brancheau, Tim-CL 2005-08-09APFIDAV1T OF CONFLICT OF INr~RF, ST
TI~ STATE OF TEXAS §
COUNTY OF DALLAS §
I, ~~[~p,~ as a .m.~.ber of the ~
make this affidavit and hereby on oath state the following: I, aha/or a p~rs%n or persons re[lind to me in the
first 4 _~2,~ by ~th~ atrmiry or consanguinity, have a subs~n~al interest in a business entity that would be
a~ those terms are
peculiarly affected by a vote or decision of the
defined in Chapt~ 171 of the Local Government Code.
Date of Meeting: ~~
!
The Business Entity is:
I have a subs~amial intcres~ in this business entity for the following reasons: (check all which are applicable)
Ownership of 10% or more of the vofin~ stock or shares of the business entity.
Owue~hip of 10% or $15,000 or more of the fair marke~ value of the business entity.
Funds received from the business entity exceed 10% of' my gross income for th~ prt~'ious
year.
Real property is involved and I have an equitable or legal ownership with a fair market value
,.~ of at least $2,500.
Upon ~ fil~ of this affdavi~ with ~ Official P.~ord Keep~ of t3~ City, I affirm ~ I will abstain from
voting on any decision involving this business entity and from any further pafficipation on this mal~xr
whaisoeve~.
Title
BEFORE lyrE, the und~signed authority, this day personally appeared'77_~ ~',o~_4~,~ ,~_ and on
oath .~t~t~,t that the facts hereinabove stated a~ true to the best of their knowledge or belief.
SWORN TO AND SUBSCRIBED BEFORE IvIE on this ~ day of
Notary ~uuc
Sate of Texas
Comm. Explr~