CF-FO-CL 2000-10-10 RECEIVED
AFFIDAVIT OF CONFLICT OF INTEREST
THE STATE OF TEXAS § 0CT 'l ! 2000
COUNTY OF DALLAS § RECORDS CENTER
CITY OF COPPELL
mal~e t~tis'aflqdavit and hereby on oath state the following: I, and/or a'pe~on~r persons related to me in the
....... a business entity that would be
/
defined in Chapter 171 of the Local Government Coae. ' .....
DateorMeeting:
AgendaltemNumber:
The Business Entity is:
I have a substantial interest in this business entity for the following reasons: (check aH which are applicable)
Ownership of 10% or more of the voting swck or shares of the business entity.
Ownership of 10% or $15,000 or more ofthe fair market value of the business entity.
Funds received from the business entity exceed 10% of my gross income for the previous
year.
Real property is involved and I have an equitable or legal ownership with a fair market value
of at least $2,500.
Upon the filing of this affidavit with the Official Record Keeper of the City, 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 ] D Jr~ day of _ . ....... ~~
"-- ' dal .......... -.,_,,,
Ti~e t
BEFORE ME, the undersigned authority, this day personally appeaj~ aJ]J JL~ . and on
oath stated that the facts hereinabove stated are true to the best of their knowledge ~j~belfef. ' ' '
S ORN 20 A/~T~* BSC.~RI~n~FORE ME on this ~ day of ~,