HomeMy WebLinkAboutConflicts Disclosure Statement-Conflict of Interest-12/14/2016 (10) LOCAL GOVERNMENT OFFICER
FORM CIS
CONFLICTS DISCLOSURE STATEMENT
(Instructions for completing and filing this form are provided on the next page.)
This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY
This is the notice to the appropriate local governmental entity that the following local
government officer has become aware of facts that require the officer to file this statement DateReceived
in accordance with Chapter 176,Local Government Code. ow
�[l l
Name of Local Government Officer LLLL
ENA e,�.�. �JJe
pDEC 12 2016 1U
CITY SECRETARY'S OFFICE
Office Held
] Name of vendor described by Sections 176.001(7)and 176.003(a), Local Government Code
JDescription of the nature and extent of each employment or other business relationship and each family relationship
with vendor named in item 3.
List gifts accepted by the local government officer and any family member, if aggregate value of the gifts accepted
from vendor named in item 3 exceeds$100 during the 12-month period described by Section 176.003(a)(2)(B).
Date Gift Accepted 12-1(Zi1(4 Description of Gift ---1-.)-\oe_S OV cA,bk- e N C2 1-1/4,.1,e,,)
Date Gift Accepted Description of Gift
Date Gift Accepted Description of Gift
(attach additional forms as necessary)
11 AFFIDAVIT
I swear under penalty of perjury that the above statement is true and correct. I acknowledge•
that the disclosure applies to each family member(as defined by Section 176.001(2), Local
Government Code) of this local government officer. I also acknowledge that this statement
-",vers the 12-month period described by Section - ! - - )(B),Local Government Code.
�"' CHRISTINE LOVEN
s )� My Notary ID#11092587
--;.',;;;;;.§0 Expires May 2,2018
Signa ure • Loc. Government Officer
AFFIX NOTARY STAMP / SEAL ABOVE ��o..,,� .(
Sworn to and subscribed before me,by the said U2_e t■L' t(r4 , this the 13 r l., day
of bece►nbe,2. 20 1(.12 , o certify which,witness my hand and seal of office.
drut;(2-L1/4.4...)
1 -,� IAr _��'�ai,Sttne LOUE� �\Lo
Signature of officer administering oath Printed name of officer administering oath Title of officer adm' istering oath
Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015