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STATEMENT OF <br />ELECTED/APPOINTED OFFICER <br />I, Amelia Leyva . do solemnly swear (or <br />affirm), that I have not directly or indirectly paid, offered, promised to pay, <br />contributed, or promised to contribute any money or thing of value, or promised any <br />public office or employment for the giving or withholding of a vote at the election at <br />which I was elected or as a reward to secure my appointment or confirmation, <br />whichever the case may be, so help me, God. <br />UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING <br />STATEMENT AND THAT THE FACTS STATED THEREINARE TRUE. <br />August 26, 2024 am"" AW V a <br />Date Signature of officer <br />City of La Porte Youth Advisory Council <br />Position to Which Elected/Appointed <br />Form No. 2201 <br />