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. .. . . ........... . ....... . <br />CERTIFICATE OF INTERESTED PARTIES <br />. ..... .... . . ..... .. .. ............ .. . . . .... . ........................ -- <br />I=01RM .1295 <br />........ ..... — — -------- - - ... <br />loft <br />...... . . ..... .. <br />Complete Nos. I - 4 and 6 It there are Interested parties. <br />OFFICE `USE `64L­'y­ ... . . ....... . . <br />Cpmplate Nos. 1, 2. 3, S. and 6 If there are no Interested parties, <br />CERTIFICATION OF FILING <br />l Name of business entity filing form, and the city, state and country of the business entity's place <br />Certificate Number - <br />of business. <br />2022-872388 <br />Richard Drake Consftctlon Company LP <br />POMERLY, TX United States <br />Date Filed. <br />. ..... i4 -a- , n 6 "o -f1-6 v- e r n' r a" n"i"a"111 e"n" tit y, or state a 9" eh't y"Ifist dis a parry ta fi' . ...... c oMiitt f 'teh-tree i�)jjnis' ...... <br />..... 041.12/2022 <br />being filed. <br />City 01 Paris <br />Date Acknowledged: <br />...... . ......... . ... . ....... . ........ . .. . ......... <br />Provide the Identification number used by the governmental entity or state agency to track or identify the contract, and provide a <br />description of the services, goods, or other property to be provided under the contract. <br />Sealed Bid: City Of Paris <br />Sealed Bid. Concrete Demolition and Construction <br />�4 <br />Nature of Interest <br />Name of Inteirested Party <br />City, State, Country (place of business) <br />(check applicable) <br />--r - <br />............... . ... . ... <br />Controlling <br />r6 <br />. .. ... . . .......... 11 ..... ..... I-'-'– <br />.. „m. ........ <br />Intermediary <br />. ................. ® ....... .. ................ ..... ... ... . .... <br />...... . ..... ... . ...... . ...... . ......... ........... <br />--- . .. ....... .. . ...................... <br />r. <br />5 Check only if there Is NO Interested Party. ❑ <br />61- U N , S" , W" 0– R", N DECLARATION ",„-” <br />My name Is 'Tt 1 IwItAc and my dale of birth Is <br />My address '60 <br />(street) (CRY) <br />(state) (zip cede) (—try) <br />I declare under penalty of perfury that the foregoing is true and correct. <br />Executed in Ln– mar —County, State of on the IJL-Aay of Apri I 2o J% <br />e. <br />(month) (Year) <br />. ...... . ....... .. ....... ... .. I <br />Signator ;Xauthorlzed agent of contracting busIness entity <br />(Declarant) <br />Forms provided by Texas Ethics Commission whwelhics.state.Mus <br />Version V1.1.191b5cdc <br />