KN-COI 2022-07-12 THE STATE OF TEXAS §
COUNTY OF DALLAS
I, J K/1 iVi / VW� ,v (printed name of aff ant) a local public official,
make this affidavit and hereby on oath state the following:
I have a substantial interest in a business entity or real property that may receive a special a nomic ct
that is distinguishable from then effect on the public by an action contemplated by the City o
Agenda Item: et„, ,,g-3, 14 da_ Hem,
,
The business entity or real property in which I have a substantial interest is: [name and address of business
and/or description of property]
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
[circle all that apply]:
(1) own 10%or more of the voting stock or shares of the business entity;
(2) own 10%or more of the fair market valued of the business entity;
(3) own$15,000 or more of the fair market value of the business entity;
(4) receive from the business entity funds that exceed 10%of [my, his, her]gross
income for the previous year;
(5) have/has an equitable or legal ownership of real property with a fair market value of$2,500 or
ore.
iolation of Chapter 171 of the Local Government Code.
Upon filing of this affidavit with the official record keeper of the city,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.
+inSigned this l2 day of dull, ,20
-.-
Signature of Affiant
UM Alt
Affiant /� (��', ',� `
BEFORE ME,the undersigned authority,this day personally appeared AO 1 1 VWL4
[name of affiant]and by oath stated that the facts herein stated are true and correct.
SWORN TO AND SUBSCRIBED BEFORE ME before me on this 12"day of V
,202 ..
„,`Vrt';/, ASHLEY M. OWENS otary Public in for the State of Texas
c'Notary Public, State of Texas Comm. Expires 02-24-2023 My commission expires: 212�/H 2023
p% %%%% Notary ID 130128128