Dickinson, John 12.09.2021 Landmark Commission 4,
AFFIDAVIT
STATE OF TEXAS §
COUNTY OF WICHITA §
I, d'i7 GVVI < C 010 /S: as a member of the A Dipt4TA-C 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 or real property that may receive a special e o omic e e t th is
i t/hgu habl from the effect on the public by an action contemplated by th
� i. / , as those terms are defined in Chapter 171 of The Texas Laca Govern od .
Date of Meeting: /2 / 3 Item No.
The business entity is 7 1! - j" f /V/
I or a person that is related to me within the first degree of consanguinity(blood)or affinity(marriage)
as defined by state law has a substantial interest in this business entity or real property for the following
reasons:
Own of 10%or more of the voting or shares of the business entity.
Own10%or more of the fair market value of the business entity.
Own$15,000 or more of the fair market value of the business entity.
Funds received from the business entity exceed 10%of my/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.
Upon filing of this affidavit with the City Clerk, I affirm that I shall abstain from voting or further
participating in any matter involving the business entity or real property, unless,allowed by law.
Signed this f�-'-73 _41 day of , 207,r( � ?
Signature of Official (9,--#14-7
Title
BEFORE ME, the undersigned authority, this day personally appeared ,bitt v\ 0IGV-i^Sov*
and by oath stated that the facts herein stated are true and correct to the best of his/her knowledge
and belief.
Sworn to and subscribed before me on this the i day of )P G-vwb L, ,20 'L I .
My Commission Expires:
Notary Public in and for the
j ?o/ 74 23 State of Texas
`41,P11", THEODORE STOLL
?i n'x Notary Public,State of Texas
STA/N./47Z Comm.Expires 08-30-2023
'',14;0‘� Notary ID 13216401.4