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Home My WebLink AboutFinancial Disclosure Statements-Financial Disclosure Statements-02/15/2018Uty or uoueyvme rmanaai visaosure ana I5usiness Lonruct or interest rorms INFORMATION STATEMENT TOTAL NUMBER OF PAGES FILED: OFFICE USE ONLY 1 NAME First, Date Received fMI (� ��/ j� LLIL E V E Last, Suffix FEB 16 2018 CITY SEGETRY'S OFFICE 2ADDRESS Address/City/St to/Zi D 11QV� l (� 7 60 3 TELEPHONE Area Code, Phone umber, Extension NUMBER J, " IDGI�� 81a3 ° REASON FOR FILING 0 EMPLOYEE (CITY MANAGER OR *SENIOR STAFF) (^ CANDIDATECi F I , l_,z,Q 1,k r r O J (INDICATE OFFICE) STATEMENT 0 ELECTED OFFICIAL l, (INDICATE OFFICE) 0 ZONING BOARD OF ADJUSTMENT (APPLICANT OR APPOINTEE) 0 PLANNING & ZONING COMMISSION (APPLICANT OR APPOINTEE) (2) business days following the end of the candidate filing period ❑Two 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. SPOUSE NAME DEPENDENT 1•�OF�� Ck�.� l� II CHILD/CHILDREN 2. NAME(S) 3. 4. COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY INITIAL HERE; =� ATE:' 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. 1 HELD OR ACQUIRED BY N FILER OSPOUSEODEPENDENT CHILD # 2DESCRIPTION Lot �'- Yo°i LC9 �� City�( Block I r r C/\ County C:� •!�V i Subdivision �) i Ad Valorum Tax Account Number 'US4 Acre(s) and Tract STREET ADDRESS STREET ADDRESS, INCLUDING CITY, COUNTY, AND STATE 4 NAME LIST THE NAMES AND ADDRESSES OF OTHER PERSONS OR BUSINESS ENTITIE WHICH OWN AN INT EST IN THE REAL PROPERTY Go i C,_�F-ZU � �� (b (,I)S' 1�� I� ti�GS� S� INDIVIDUAL BUSINESS d-Ct)�-Lbbc T )( HELD OR ACQUIRED BY FILER SOUSE DEPENDENT CHILD #_ 2DESCRIPTION Lot City Block County Subdivision Ad Valorum Tax Account Number Acre(s) and Tract 3 STREET ADDRESS STREET ADDRESS, INCLUDING CITY, COUNTY, AND STATE 4 NAME LIST THE NAMES AND ADDRESSES OF OTHER PERSONS OR BUSINESS ENTITIES WHICH OWN AN INTEREST IN THE REAL PROPERTY E INDIVIDUAL -Q BUSINESS COPY AND ATTACH ADDITIONAL PAG AS NECESSARY ❑ NOT APPLICABLE INITIAL HER DATE: �/8 Uly OI UU1ley Ville nudlludl uIDUWwe duu ouSlueSS l Ull IlU ill 11lt.eleM1 rill Ib FEE, SALARY, OR GIFT Section 2 The name and address of any person or corporation which currently preceding twelve (12) months has had a direct or indirecrelationship with the City and from which the person(s), their spouse,tminor children have received a fee, salary, or gift of value exceedingeddollars /ordurinthe ($100.00). When reporting information about a dependent child's actvity, indiildabout whom you are reporting by providing the number under whiis listed on the Information Statement. ' RECIPIENT = FILER =SPOUSE =DEPENDENT C ILD #_ 2FEE, SALARY, GIFT NAME AND ADDRESS DESCRIPTION OF FEE, SALARY, GIFT 'RECIPIENT =FILER =SPOUS =DEPENDENT CHILD #_ Z FEE, SALARY, GIFT NA E AND ADDRESS DESCRIPTION OF FEE, SALARY, GIFT 'RECIPIENT =FILER =SPOUSE =DEPENDENT CHILD #_ Z FEE, SALARY, GIFT NAME AND ADDRESS a DESCRIPTI OF FEE, SALARY, G T COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY NOT APPLICABLE INITIAL HEREXl/ DATE2/ 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 ith the City, of which person(s), their spouse, or any dependent minor children own m re than two percent (2%) of the outstanding equity interest or more than two percent (2 0) of the assets. When reporting information about a dependent child's activity, indicate the hild about whom you are reporting by providing the number under which the child is sted on the Information Statement. 'HELD OR ACQUIRED BY =FILER =SPOUSE =DEPENDENT C LD # 2DESCRIPTION NAME AND ADDRESS 'NATURE OF BUSINESS 'HELD OR ACQUIRED BY DEICER =SPOU E =DEPENDENT CHILD # 2DESCRIPTION NAME AND ADDRESS f 3 NATURE OF BUSINESS 'HELD OR ACQUIRED BY =FILER =SPOUSE =DEPENDENT CHILD # 2 DESCRIPTION NAME AND ADDRESS f r' 3NATUREOF USINESS COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY n NOT APPLICABLE INITIAL HERE DATEL s o Financial Disclosure and Business Conflict of Interest Disclosure Area Map N ci/ \ E �- W S COLLEYVILLE The map includes Tarrant, Denton, and Dallas Counties. City 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. Befor�i� me, the �' , J undersigned authority, personally appeared: 7` ,,I,l C� i who, after being duly sworn upon their oath and deposed anq stated as follows: "My name is ( /�.�K it ellif 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." s Affiant to and subscribed before me, this the &A -day of 'If-e4 1 e��_, 20� tr: . CHRISTINE LOVEN My Notary ID # 11092587 '•'.:oF�m*.• Expires May 2,2018 Notary Public, State of Texas A INITIAL HERE: ---,.,DATE: ��