HomeMy WebLinkAboutConflict of Interest-Conflict of Interest-9/6/2022STATE OF TEXAS:
COUNTY OF TARRANT:
AFFIDAVIT
The undersigned, as a member of the City of Colleyville (name of board or commission)
_________________________________________________________makes this Affidavit relative to
item number ____________ on the __________________________________ agenda dated the
_______ day of __________________ 20____, and hereby on oath states the following:
I, and/or a person or persons related to me, are within the notification area, or in the below names
business entity, that would be peculiarly affected by a vote or decision of the Colleyville (name of
board or commission)__________________________________________________ as those terms are
defined in Section 171.001, etc. seq., Texas Local Government Code.
The business entity is (name)____________________________________________________ located at
(address) ___________________________________________________________________________.
I, and/or such relative or relatives have a substantial interest in this business entity for the following
reasons: (Check all which are applicable.)
( ) Own 10% or more of the voting stock or shares of the business entity or of the fair market
value of the business entity. The business entity is likely to receive an economic benefit if a
title insurance policy is issued on the property in the above entitled case.
( ) Own $5,000 or more of the fair market value of the business entity.
( ) Funds received from the business entity exceed 10% of my and/or such relative’s or
relatives’ income for the previous year.
( ) Real property is involved and I, and/or my relative or relatives have an equitable or legal
ownership with a fair market value of at least $2,500.
( ) A relative of mine 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 the filing of this Affidavit with the City Secretary of the City of Colleyville, I affirm that I will abstain
from voting on any decision involving this business entity and from any further participation on this
whatsoever.
SIGNED this _____ day of ____________________ 20_____.
___________________________________________________
Signature of Official
___________________________________________________
Title
BEFORE ME, the undersigned authority, this day personally appeared
_____________________________________________, and on oath stated that the facts hereinabove
stated are true to the best of his/her knowledge or belief.
Sworn to and subscribed to before me on this ________ day of __________________________ 20____.
___________________________________ _______
Notary Public in and for the State of Texas
My Commission Expires:______________________