Beruflich Dokumente
Kultur Dokumente
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Thebusiness
entiryis gnrko vB,lpne?ls
, / C.
tt@,ir{'t './ {rP
A
UP'ttA., rr 'Z{Za,
(name and addressand,/ordescriptionofproperty)
{ Ownership of 10o/"or $15,000.00 or more of the fair market value of the business
entity.
Funds received from the business entity exceed l}oh of -gross income for the
previous ycar.
(my, her, his)
A relative of mine related in the first degree by either affinity or consanguinity has a
substantial interest in the business entity or property that would be affected by a
,/ dccisionof the public body of which I am a mcmber.
E- ftt 4 nP17y. a{ft&sio."+/e*+i
Uponthefiling of thisaffidavitwiththeCity Secretary,
or ActingCity Secretary,
I affirmthatI will
abstain from voting on any decision involving this busincss entity or real properly and from any
further participation in this matter whatsocver.
Title
BEFOREME, theundersigned
authority,
thisdaypersonallyupp"*"aWrkj4frq{iltut"f
"ry"
affiant) and on oath stated that the facts hereinabove stated are true to the best of -.(i-
knowledge or belief.
ftislher)