Lee, Andy 01.26.2016AFFIDAVIT FOR CONFLICT OF INTEREST
STATE OF TEXAS )(
COUNTY OF WICHITA )(
as a member of the +�ww,...cn�� make this
affidavit and hereby on oath state the following: I and/or a person or persons related to me, have a
substantial interest in a business entity that would be peculiarly affected by a vote or decision of the
, as those terms are defined in Chapter 171 of The Texas Local
Government Code.
Date of Meeting: /--24 — 2d/4
The business entity is:
Business Nam
Address
Item No.: # / lit A,. 04-�
VAS �P4
(I c�A 4 .—ft, ^-;,
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 stock 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 (he/she) has an equitable or legal ownership with a fair market
value of at least $2,500.
&V A4t—,o In --- h A tT
// 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 -A' tl day of - , 20�,
Signature of Official
Title
BEFORE ME, the undersigned authority, this day personally appeared aaL-U -�' I uz
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 <D day of �Ahva\ v�3 201 � .
; TRACY R NORR
v My Notary ID # 8363834
=:'•`'' Expires September9,2017 �Ffotarytbl in and for the
State of Texas