Dickinson, John 06.23.2020AFFIDAVIT
STATE OF TEXAS )(
COUNTY OF WICHITA
1,k7n,44tD;6ei1Z-S t & a member of the69 L�/��719/✓" make this affidavit and hereby on oath
state the following: I and/or a person or persons rel dl tome, have a substantial inter tin a
bu ingss pntity that would be peculiarly affected by a vote or decision of the zAcyn ,t,' 4�-
� > , as those terms are defined in Chapter 171 of The Texas Local Government Code.
Date of Meeting:�2(2 fj�' �� r— Item No.
The business entity is
(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 jilis usipess entity and from y further participation on this matter whatsoever.
Signed thiL41 of ` , 20-
Signature of Official
Title
BEFORE ME, the undersigned authority, this day personally appeared ,UV1✓� 'NC�f � l
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 I q day of �VV\-Q- , 20 70
My Commission Expires:
z3
Notary Public in and for the
State of Texas
oppY PV///� ERN HAM
N�: Notary Public, State of Texas
Comm. Expires 08-30-2023
/i„°„�..� Notary ID 132154014