Derr, Michele 06.22.2021 Landmark Commission AFFIDAVIT
STATE OF TEXAS )(
COUNTY OF WICHITA )(
I,O1)cJ k -iV(C , as a member of theL ld'radL CUn)mmake 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
usiness entity that would be peculiarly affected by a vote or decision of theL ())-NA ty t C IL
/ m.SW\- , as those terms are defined in Chapter 171 of The Texas Local Government Code.
Date of Meeting:DU'\ E 1* gm Item No. 3
The business entity is `0+')oY 1 C ) T T-uA -f L-1- [\
I (have/has) a substantial interest in this business entity for the following reasons: (Check all which
are applicable.)
7\L 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 Clerk1, 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 2-2_nd day of A-An , 20 2 1
ilAAU it 6),
Signature of Official
�•al. iv ,is
Title 1
BEFORE ME, the undersigned authority, this day personally appeared I(�k//I ,_EYrr
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 2 ,day of ,J UJ'-& , 20.21 .
My Commission Expires: 'l aiA-i-- gt-eqlvvia
�/
/2-)
Nota'y Public in and fob-the
10 /) c' State of Texas
r
4 .•;:nvN; MARIE BALTHROP r
4 ,; �,`� Notary Public,State of Texas P
' j� My Commission Expires.�� October 26,2023
``",:•es:, NOTARY ID 1173862-1