Lee, Andy 05.23.2017AFFIDAVIT
STATE OF TEXAS )(
COUNTY OF WICHITA )(
I, ��dwr.�� , as a member of the make make this affidavit and hereby on oath
state the following: I and/or a person or persons related to me, have a substantial interestin a
business entity that would be peculiarly affected by a vote or decision of the 1,#&4W pw�Cr�+A�ss��✓
, as those terms are defined in Chapter 171 of The Texas Local Government Code.
Date of Meeting: fl-?M7 Item No_:s-- Am�'A�/O
The business entity is iYLd'G
I (have/has) a substantial interest in this business entity for the following reasons: (Check all which
are applicable.)
-Z 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 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 :;L3 --1-+ day of rN , 20iq
Signature of Official
Title
BEFORE ME, the undersigned authority, this day personally appeared Ptv.�-v LLC'
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 a3'1'4day of ►m , 20�_.
;• S.... TWY B. NORR
My Commission Expires: MyN0WY10#836 N
,j:'` Fxpir september9.20�7 ary Public and for the
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o1'`1' ��� 1 _ State of Texas