Dickinson, John 08.24.2021 Landmark Commission AFFIDAVIT FOR CONFLICT OF INTEREST
STATE OF TEXAS )(
COUNTY OF WICHITA )( G,46--1 u,(Zl6 1C
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I,\/fl l /( I�Gi ue a member of the �' �,��v!!" make this affidavit and hereby
on oath state the following: I and/or aperson or ers��lated to me, have a substantial inte st in a
9 perso
entity that would be peculiarly affected by a vote or decision of the4,INDt4 as
those terms are defined in Chapter 171 of The Texas Local Government Code.
Date of Meeting: 7- 2,c7z Z / Agenda Item No.: z
1
The business entity is: ,d,erj/tee.5
Busines
A ress
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.
C4eal property is involved and (he/she) 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.
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Sign d this ! day of i / , 20 /24
(Si ature of Official
Title
BEFORE ME, the undersigned authority,this day personally appeared ,-;•ItAt'\ 1-1.1 C
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 1 L day of , 20 1 .
W:1,- A
4Pnv1 THEODORE STOLL _
P;j��:Notary Public, State of Texas Notary Public in and for the
� :�"`•.cs� Comm.Expires 08-30-2023 State of Texas
'',,2, ` Notary ID13215401-4