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Home My WebLink AboutFinancial Disclosure Statements-Financial Disclosure Statements-03/24/2021City 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 mer Lob .the �unJdersigned authority, personally appeared: Lo 'P—"C .2 who, after being duly sworn upon their oath and deposed and stated as follows: "My name is � 2k t-a E and I hereby submit for filing the attached Finan ial 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 then day of U UZ I 20 0 • �• My Notary ID # 11092567ILI May 2,2022 Notary Public, State of Texas INITIAL HERE: ICJ , DATE: 3-2c(-2il City of Colleyville Financial Disclosure and Business Conflict of Interest Forms INFORMATION STATEMENT TOTAL NUMBER OF PAGES FILED: OFFICE USE ONLY 'NAME First, MI Date Received OTH[Zyr AT1411 S Last, Suffix W KEI�T RECEIVED MAR 2 4 2021 2 ADDRESS Address/City/State/Zip 2010 COI.DDJ LT Cgt,CI= jV(LI,C Tjc -:70034 CSD 3 TELEPHONE Area Code, Phone Number, Extension NUMBER HI5 2)8 q{ 30 ° REASON 0 EMPLOYEE (CITY MANAGER OR *SENIOR STAFF) FOR FILING = CANDIDATE (INDICATE OFFICE) STATEMENT ['�Q ELECTED OFFICIAL 9LhCG 3 Cla COVNL0., (INDICATE OFFICE) n ZONING BOARD OF ADJUSTMENT (APPLICANT OR APPOINTEE) 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 GNIZQOV iwm>FPoRO Wrtf-ItT DEPENDENT 1. W(Ki LMA)( WKU-v NT CHILD/CHILDREN 2 S?e:P Cy WK EfiT NAME(S) 3. 4. COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY INITIAL HERE: (xj DATE: 3-24'Zl 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. 1 HELD OR ACQUIRED BY LXI FILER LXJSPOUSE DEPENDENT CHILD # Z DESCRIPTION Lot 21 city COLLOVII-L; Block G County TAKIZAN 7 Subdivision WW1A1DNT Ad Valorum Tax Account Number Pool Tlonl 0-4(p9u207- Acre(s) and Tract 01 L 7 3 STREET ADDRESS STREET ADDRESS, INCLUDING CITY, COUNTY, AND STATE 20t-a- lower j C T- boLLEYv►u-E -fX -qloo3Li 'NAME LIST THE NAMES AND ADDRESSES OF OTHER PERSONS OR BUSINESS ENTITIES WHICH OWN AN INTEREST IN THE REAL PROPERTY Q INDIVIDUAL Q BUSINESS 1 HELD OR ACQUIRED BY FILER SPOUSE D DEPENDENT CHILD # Z DESCRIPTION Lot City Block County Subdivision Ad Valorum Tax Account Number Acre(s) and Tract 3 STREET ADDRESS STREET ADDRESS, INCLUDING CITY, COUNTY, AND STATE 'NAME LIST THE NAMES AND ADDRESSES OF OTHER PERSONS OR BUSINESS ENTITIES WHICH OWN AN INTEREST IN THE REAL PROPERTY Q INDIVIDUAL Q BUSINESS COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY ❑ NOT APPLICABLE INITIAL HERE:__ DATE: 3'2y' 21 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. 'RECIPIENT =FILER =SPOUSE =DEPENDENT CHILD # 'FEE, SALARY, GIFT NAME AND ADDRESS 3 DESCRIPTION OF FEE, SALARY, GIFT 'RECIPIENT =FILER =SPOUSE =DEPENDENT CHILD # ' FEE, SALARY, GIFT NAME AND ADDRESS DESCRIPTION OF FEE, SALARY, GIFT 'RECIPIENT =FILER =SPOUSE =DEPENDENT CHILD # 'FEE, SALARY, GIFT NAME AND ADDRESS 3 DESCRIPTION OF FEE, SALARY, GIFT COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY IX NOT APPLICABLE INITIAL HERE: PvJ DATE: 3'Z4 2 1 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 =FILER =SPOUSE =DEPENDENT CHILD # ZDESCRIPTION NAME AND ADDRESS 3 NATURE OF BUSINESS 'HELD OR ACQUIRED BY =FILER =SPOUSE =DEPENDENT CHILD # 2 DESCRIPTION NAME AND ADDRESS 3 NATURE OF BUSINESS 1 HELD OR ACQUIRED BY =FILER =SPOUSE =DEPENDENT CHILD # 2DESCRIPTION NAME AND ADDRESS 3 NATURE OF BUSINESS COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY NOT APPLICABLE INITIAL HERE: IGI'l.4 DATE: 3-2H-ZI Financial Disclosure and Business Conflict of Interest Disclosure Area Map N GtT� W E COLLEYVILLE S The map includes Tarrant, Denton, and Dallas Counties.