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10202003 October 20, 2003 Attachment October 20. 2003 fi A. MAX BACON, MAYOR 7;fW (l~ e:l~..d6/~ CHARLES PETE WOOD, WARD 7 16 - a.lUJ~/Y1 0 IId16 -' SUSAN D. HIOTT, CITY CLERK PAUI!,A A. WEEKS, WARD 4 WADE S. LNENICKA, WARD 6 - - ,- Applicant: Cobb County Habitat for Humanity, Inc. Application No.: Z03-020 (2003) ,... DISCLOSURE REPORT BY APPLICANT ~""". 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 ,... 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 "",.,.. r ZONING DISCLOSURE REPORT (Continued) /' 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 ,... Kevin Moore, Georgia Bar No. 519728 (Attorney's Signature, ifappIicable) Attorneys for Applicant and Property Owner ,...