Dickinson, John 11.22.2019AFFIDAVIT
STATE OF TEXAS )(
COUNTY OF WICHITA )(
member of the make this affidavit and hereby on oath
state the following: I and/or a person or person' eINted to me, have a substantial i terest in a
business entity that would be peculiarly affected by a vote or decision of the �C1;
Ce'/, as those terms are defined in Chapter 171 of The Texas Local Government CocTe.
Date of Meeting: l - 7�G — Item No.
The business entity is L �C%��� /�� b
I (have/has) a substantial interest in this business entity for the following reasons: (Check all which
are applicable.)
Ownership of 10% or more of the voting or shares of the business entity.
Ownership of $5,000 or more of the fair market value of the business entity.
Funds received from the business entity exceed 10% of his/her income for the previous year.
Real property is involved and his/her has 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 Clerk.,, 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 2 day of AL,kjRrn�,e r420 2(� I 3{r ,
;41
i
Signature of Official
Title v
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 and
belief.
Sworn to and subscribed before me on this the U day of NoVe r-202-0
tPPY P
My Commission Expires _°�� JENNY BURNS
COMM. EXPIRES &06-2022
NOTARY ID 182158-6 N t ry Public" and for the
-in` 22 State of Texas