10202003 October 20, 2003 Attachment
October 20. 2003
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A. MAX BACON, MAYOR
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CHARLES PETE WOOD, WARD 7
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SUSAN D. HIOTT, CITY CLERK
PAUI!,A A. WEEKS, WARD 4
WADE S. LNENICKA, WARD 6
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Applicant: Cobb County Habitat for Humanity, Inc.
Application No.: Z03-020 (2003)
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DISCLOSURE REPORT BY APPLICANT
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Has the applicant* made, within two years immediately preceding the filing of this
application for rezoning, campaign contributions aggregating $250 or more or made gifts
having in the aggregate a value of$250 or more to the Mayor or any member of the City
Council or Planning and Zoning Board who will consider this application?
Yes.
If so, the applicant* and the attorney representing the applicant* must file a disclosure
report with the Mayor and City Council of the City of Smyrna, within 10 days after this
application is first filed.
Please supply the following information, which will be considered as the required
disclosure:
The name of the Mayor or member of the City Council or Planning and Zoning Board to
whom the campaign contribution or gift was made:
Mayor Max Bacon
The dollar amount of each campaign contribution made by the applicant* to the Mayor or
,... any member ofthe City Council or Planning and Zoning Board during the two years
immediately preceding the filing of this application, and the date of each such
contribution:
$500.00 on September 24, 2003
An enumeration and description of each gift having a value of $250 or more by the
applicant* to the Mayor or any member of the City Councilor Planning and Zoning
Board during the two years immediately preceding the filing of this application:
Political Contribution
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Does the Mayor or any member of the City Council or Planning and Zoning Board have a
property interest (direct or indirect ownership including any percentage of ownership less
than total) in the subject property?
No, to the best of our knowledge, information, and belief.
If so, describe the nature and extent of such interest
Not Applicable
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ZONING DISCLOSURE REPORT (Continued)
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Does the Mayor or any member of the City Council or Planning and Zoning Board have a
financial interest (direct ownership interests of the total assets or capital stock where such
ownership interest is 10% or more) ofa corporation, partnership, limited partnership,
firm, enterprise, franchise, association, or trust, which has a property interest (direct or
indirect ownership, including any percentage of ownership less than total) upon the
subject property?
No, to the best of our knowledge, information, and belief.
If so, describe the nature and extent of such interest No tap plica b Ie .
Does the Mayor or any member of the City Council or Planning and Zoning Board have a
spouse, mother, father, brother, sister, son, or daughter who has any interest as described
above? No, to the best of our knowledge, information, and belief.
If so, describe the relationship and the nature and extent of such interest
Not applicable.
"... If the answer to any of the above is "Yes", then the Mayor or the member of the City
COl,lIlCil or Planning and Zoning Board must immediately disclose the nature and extent
of such interest, in writing, to the Mayor and City Council of the City of Smyrna. A copy
should be filed with this application. Such disclosures shall be a public record and
available for public inspection any time during normal working hours.
We certify that the foregoing information is true and correct, this
of October .~---7003.
20th
day
LLP
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Kevin Moore, Georgia Bar No. 519728
(Attorney's Signature, ifappIicable)
Attorneys for Applicant and Property Owner
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