Lane, Leo 10.26.2021 LOCAL GOVERNMENT OFFICER CONFLICTS FORM-FM
DISCLOSURE STATEMENT I
(Instructions for completing and filing this form are provided on the next page.)
This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE US4 Mkt
This is the notice to the appropriate local governmental entity that the following local
government officer has become aware of facts that require the officer to file this statement Date Rey ived
in accordance with Chapter 176, Local Government Code. U ~
1 Name of Local Government Officer O
Leo Lane Z y�
2 Office Held W W
President WFEDC >_ v —
w
3 Name of vendor described by Sections 176.001(7)and 176.003(a), Local Government w
Code James Lane Air Conditioning Co. Inc cc v o m
8600 Central Ventures
4 Description of the nature andeAtont of each em loy ent or other
.o. Inc
Partner in 8600 Central Ventures
5 List gifts accepted by the local government officer and any family member, if aggregate value of the gifts accepted
from vendor named in item 3 exceeds $100 during the 12-month period described by Section 176.003(a)(2)(B).
Date Gift Accepted None Description of Gift
Date Gift Accepted None Description of Gift
Date Gift Accepted None Description of Gift
(attach additional forms as necessary)
6 SIGNATURE I swear under penalty of perjury that the above statement is true and correct. I acknowledge that the disclosure applies
to each family member (as defined by Section 176.001(2). Local Government Code) of this local government officer. I
also acknowledge that this statement covers the 12-month period described by Section 176.003(a)(2)(B), Local
Government Code. .Z-CN gCA/ .„
Signature of Local Government Officer
Please complete either option below:
(1)Affidavit
NOTARY STAMP/SEAL
Sworn to and subscribed before me by this the day of
20 , to certify which,witness my hand and seal of office.
Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath
OR
(2) Unsworn Declaration
My name is Leo Lane , and my date of birth is
My address is 2403 Martin Street ,Wichita Falls , TX ,76308 , USA
(street) (city) (state) (zip code) (country)
Executed in Wichita County, State of TX ,on the 26 day of 10 ,2021
(month) (year)
Signature of Local Government Officer (Declarant)
Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020