Hooker, Brian 03.30.2017AFFIDAVIT FOR CONFLICT OF INTEREST
STATE OF TEXAS )(
COUNTY OF WICHITA )(
I, gr;a✓% gke- as a member of the L• 4 7� UIP make this affidavit and hereby
on oath state the following: I and/or a person or p rsons related to me, have a substantial interest in
a business entity that would be peculiarly affected by a vote or decision of the as
those terms are defined in Chapter 171 of The Texas Local Government Code.
Date of Meeting: 3 - 3° -
The business entity is: A, P.-/
Business Name
Address
Agenda Item No.:
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.
Real 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.
Signed this day of J°�Q'� G`— , 20 ?IW !?
Signature of Official
G• �,i l ,,.... •/ � -ram �
Title
BEFORE ME, the undersigned authority, this day personally appeared �''� (,try-koOj,"e.t-
and on oath stated that the facts hereinabove stated are true to the best of 1Pi /her)
knowledge and belief.
Sworn to and subscribed before me on this the 5 04 day of CClU6\ , 20 Lq .
LINDA MERRILL
Notory Public, State of Texas
Comm. Expires 12-22-2018 Notary Public in and for the
'•.,;,��;;�.�� Notary ID 482691-4 State of Texas