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Home My WebLink AboutFinancial Disclosure Statements-Financial Disclosure Statements-08/08/2018City of Colleyville Financial Disclosure and Business Conflict of Interest Forms PERSONAL FINANCIAL STATEMENT AFFIDAVIT Financial Disclosure and Business Conflict of Interest Forms shall be provided by candidates for Mayor and City Council and by applicants seeking appointments to the Planning and Zoning Commission or the Zoning Board of Adjustment, and shall file such forms within two (2) business days following the end of the candidate filing period, or if for appointment, within (2) business day following the end of the application period stated in the official City advertisement for application for the position. The city manager and the city manager's senior staff members (including any staff member who is appointed with City Council approval) shall also file the same within thirty (30) days of hiring. All person(s), as outlined above, shall have a duty to file supplemental disclosures annually and within five (5) business days of an occurrence of any change in the information reflected in the forms previously filed by the individual. Before me, the undersigned authority, personally appeared: 'I) , - I, _ who, after being duly sworn upon their oath and deposed and stated as follows: "My name is D rf z� � , e r vy.t , n and I hereby submit for filing the attached Financial Disclosure and Business Conflict of Interest forms. I have personal knowledge of all information contained in said forms and all information contained in the forms is true and correct." "Further, all information contained in the forms is complete. There is no information that has been withheld or not disclosed which is responsive to or required to be disclosed by the forms." Affiant Sworn to and subscribed before me, this the '" day of 20 t�,y, CYNTHIATREJO P��t+ Notary Public ., * ' STATE OF TEXAS State of INITIAL HERE: _DK DATE: glyllf City of Colleyville Financial Disclosure and Business Conflict of Interest Forms INFORMATION STATjMENT TOTAL NUMBER OF PAGES FILED: First, MI OFFICE USE ONLY I NAME Date Received 0—e Last, Suffix ZADDRESS Address/City/State/Zip v �1 ��«d C o //-eVL/, il_ ��' �� 3 y 3 TELEPHONE Area Code, Phone Number, Extension NUMBER R/ .7_ z11 �, _ � 7 �7 ° REASON 0 EMPLOYEE FOR FILING 1-1 CANDIDATE (CI Y MANAGER OR *SENIOR STAFF) STATEMENT 0 ELECTED OFFICIAL (INDICATE OFFICE) ZONING BOARD OF ADJUSTMENT (APPLICANT OR APPOINTEE) (INDICATE OFFICE) PLANNING & ZONING COMMISSION (APPLICANT OR APPOINTEE) Two (2) business days following the end of the candidate filing period or if appointment, following the end of the application period stated in the official city advertisement for the position. Supplemental disclosure filed annually and within five (5) business days of an occurrence in previously filed form. *SENIOR STAFF is defined as those employees who are classified as directors and above in the City's classification system and the City Manager and City Secretary. s SPOUSE NAME DEPENDENT i. CHILD/CHILDREN NAME(S) 2. 3. 4. COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY INITIAL HERE: -/ K DATE: _ 4 ,S /,S/ City of Colleyville Financial Disclosure and Business Conflict of Interest Forms INTERESTS IN REAL PROPERTY Section 1 Describe the location, size, and current use of all property owned within the included map, or held in trust by the filer, spouse, and any dependent minor children, or any business entity in which the person has a financial interest. When reporting information about a dependent child's activity, indicate the child about whom you are reporting by providing the number under which the child is listed on the Information Statement. HELD OR ACQUIRED BY DESCRIPTION Lot FILER J2S1SPOUSEL-JDEPENDENTCHILD # " County Subdivision Ad Valorum Tax Account Number Acre(s) and Tract STREET ADDRESS STREET ADDRESS, INCLUDING CITY, COUNTY AND STATE to U l (p L D L o c k- f% le - Co l &1V Tk 7 re e 3 v ° NAME LIST THE NAMES AND ADDRESSES OF OTHER PERSONS OR BUSINESS ENTITIES WHICH OWN AN INTEREST IN THE REAL PROPERTY INDIVIDUAL 0 BUSINESS HELD OR ACQUIRED BY FILER SPOUSE DEPENDENT CHILD # DESCRIPTION — Lot City County Ad Valorum Tax Account Number qAcre(s)and TractSTREET ADDRESSEET ADDRESS, INCLUDING CITY, COUNTY, AND STATE lley� �l� 7 k _7Cdv3V NAME HE NAMES AND ADDRESSES OF OTHER PERSONS OR ESS ENTITIES WHICH OWN AN INTEREST IN THE REAL ,�c:L, k;d lrC�-er/; SLL� �BUSINEDSSAL �;' led D C a ck/ t/ CTX 76,03`1 COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY ❑ NOT APPLICABLE INITIAL HERE: DATE: City of Colleyville Financial Disclosure and Business Conflict of Interest Forms FEE, SALARY, OR GIFT Section 2 The name and address of any person or corporation which currently has or during the preceding twelve (12) months has had a direct or indirect contractual relationship with the City and from which the person(s), their spouse, or dependent minor children have received a fee, salary, or gift of value exceeding one hundred dollars ($100.00). When reporting information about a dependent child's activity, indicate the child about whom you are reporting by providing the number under which the child is listed on the Information Statement. 1 RECIPIENT = FILER =SPOUSE =DEPENDENT CHILD # 2FEE, SALARY, GIFT NAME AND ADDRESS DESCRIPTION OF FEE, SALARY, GIFT 'RECIPIENT =FILER =SPOUSE =DEPENDENT CHILD # Z FEE, SALARY, GIFT NAME AND ADDRESS DESCRIPTION OF FEE, SALARY, GIFT 'RECIPIENT =FILER =SPOUSE =DEPENDENT CHILD # 'FEE, SALARY, GIFT NAME AND ADDRESS a DESCRIPTION OF FEE, SALARY, GIFT COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY NOT APPLICABLE INITIAL HERE:_D 9 DATE:/ City of Colleyville Financial Disclosure and Business Conflict of Interest Forms BUSINESS INTERESTS Section 3 The name and address of any corporation or business, which currently has or in the preceding twelve (12) months has had a direct or indirect contractual relationship with the City, of which person(s), their spouse, or any dependent minor children own more than two percent (2%) of the outstanding equity interest or more than two percent (2%) of the assets. When reporting information about a dependent child's activity, indicate the child about whom you are reporting by providing the number under which the child is listed on the Information Statement. 1 HELD OR ACQUIRED BY DESCRIPTION NATURE OF BUSINESS 1 HELD OR ACQUIRED BY 'DESCRIPTION NATURE OF BUSINESS 1 HELD OR ACQUIRED BY 'DESCRIPTION NATURE OF BUSINESS COPY AND ATT =FILER =SPOUSE =DEPENDENT CHILD # NAME AND ADnRFsc =FILER =SPOUSE =DEPENDENT CHILD # NAME AND ADDRESS =FILER =SPOUSE =DEPENDENT CHILD # NAME AND ADDRESS ADDITIONAL PAGES N a NOT APPLICABLE INITIAL HERE: I< DATE: � � cY