The URL can be used to link to this page

Home My WebLink AboutMark Alphonso Financial Disclosure and Business ConflictCity of Colleyvilfe Financial Disclasure and Business Conflict of Interest Forms INFORMATI4N STATEMENT i�TAL NUMBER QF PAGES FIL�p: � OFFICE USE ONLY i NAME First, MI Daie Received � O�f' � Last, Suf#ix � �o ,n3 o R,�'��1�1�� 2 ADDRESS Address/ ity/State/zi� �� Q�� CS �� V i � �2. �� p�y ��°��y�'� ��'a�� 3 TELEPHONE Area Code, Phone rvumber, Extensian NUMBER �I �,,,� � �� . � � �� a REASON � EMPLQYEE (CITY MANAGER dR *SENIOR STAFF} FOR FILING 0 CANDIDATE (TNDICATE OFFICE) STATEMENT 0 ELECTED �FFICIA� {INDICATE OFFICE} � ZON�NG BOARD OF ADJUSTMENT (APPucAKT OR ,appOIN�EE) � pLANNING & ZON�NG COMMTSSIQN �aPPucnNroRaPPowree> ❑Two {2) business days fa![owing the end of the candidate fi{ing period or if appointment, foliowing the end of the application period stated in the official city advertisement for the posi�ion. �Supplemental disclosure filed annually and within fi�e (5) business days of an a�ccurrence in previously filed form. *SENIOR STAFF is defined as those emplayees wha are classifEed as directors and above in tl�e City's classification sys�em and the City Manager and City Secretary. s SPOUSE NAME e' e � DEPENDENT 1• �'�x°' ' S� CHILD/CHILDREN , 2. o� � NAME(S} 3. 4. COPY AND ATTACH ADDITIONA! PAGES AS NECESSARY INIT�AL HERE: ��" DATE: � 13 �`� City of Colleyville Financial Disclasure and Business ConFfict 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 �eld in trusi by the filer, spouse, and any dependent minor children, or any business entity in which the person has a financial interest. When reporting information abaut a dependeni child's ac�i�ify, indicate the child about whom yo� are reparting by providing ��te number under which the child is listed on the Information 5tatement. 1 HE�D OR ACQUIRED BY FILER SPOUSE DEPENDENT CNILD #�, � �ESCRIPTION �ot � ��tY �o I �� ,� [te �o M� Block � County rar��x„ � C�i�� v;tlt TX �� f 5u6clivision �SnYlar� �� Ad Valorum Tax Account Number �'�r �"s� S b l Acre(s) and Tract . 0 STR��T ADDRESS STRFFT Af)f)RF�S_ TNCI l IF7�N(; CITY, COUNTY, AND STATE �.el��.e,��;i(� �jC lba��$ 4 NAME LIST THE NAMES AND ADDRESSES OF OTHER PERSONS OR BUSINESS EI�TIT�ES WHICH OWN AN IIVTEREST IN THE REAL PROPERTY 0 INDIVIDUAL 0 BUSTNESS 1 HELD OR ACQUIRED BY FILER SPOUSE DEPEN�ENT CHILD # � DESCRIPTION �► s�r� s S �'� �� G� ��Y �� I 4�. �� tte � DAl Li�o..� Black � Caunty I e�rr� T Suhdivision � i/��n C�et�` Ad Valorum Tax Account Numher �{�`'�3 � O lto Acre(s) and Tract � • �.� 3 STREET ADDRESS STREET AbDRESS, INCLUbING CITY, COUNTY, AND STATE � 5 0� Co II.t•�J � 4�e �1�� td l 1.�,7 ,►,- (�t `r' �( 7 6 0 3� 4 NAME LIST THE NAMES AND ADDRESSES OF OTHER PERSONS OR BUSIIVESS ENTITIES WHICH OWN AN II�TEREST IN THE REAL PROPERTY ��k � ��on�ca 1nv I�;M; �� Co1{.e�✓;� ?6 �INDIVTDUAL .��Z �V4 l�alJi��s �..�G �Sa�{ Gal.{t�,,;rl{ �I�` , eoil� �,�l� �USINFSS 1 f,o]� COPY AND ATTACH ADDITIONA! PAGES AS NECESSARY '�`� �x ❑ NOT APP�ICABLE INITIAL MERE:_� DATE: /3 �'t( 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 0 FILER OSPOUSE ODEPENDENT CHILD # 2FEE, SALARY, GIFT NAME AND ADDRESS 3 DESCRIPTION OF FEE, SALARY, GIFT 1 RECIPIENT �FILER OSPOUSE ODEPENDENT CHILD #_ z FEE, SALARY, GIFT NAME AND ADDRESS DESCRIPTION OF FEE, SALARY, GIFT 1 RECIPIENT OFILER OSPOUSE ODEPENDENT CHILD # 2 FEE, SALARY, GIFT NAME AND ADDRESS 3 DESCRIPTION OF FEE, SALARY, GIFT COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY �NOT APPLICABLE INITIAL HERE:� DATE: 6'�3�a� 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 #_ Z DESCRIPTION NAME AND ADDRESS 3 NATURE OF BUSINESS 1 HELD OR ACQUIRED BY OFILER �SPOUSE ODEPENDENT CHILD #_ ZDESCRIPTION NAMEAND ADDRESS 3 NATURE OF BUSINESS 1 HELD OR ACQUIRED BY OFILER OSPOUSE ODEPENDENT CHILD #_ 2 DESCRIPTION NAME AND ADDRESS 3 NATURE OF BUSINESS COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY �NOT APPLICABLE INITIAL HERE:� DATE: %/3 2y 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. Before me, the undersigned authority, personally appeared: �,/��, � who, after being duly sworn upon their oath and deposed and stated as follows: "My name is o,�t� ,,��A�onSo 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." nA . ,4 I Affiant Sworn to and subscribed before me, this the � day of ��C� �. , 200�� :7�� JUN � � 2�24 �:it,� �ec��tary � �ffiee INITIAL HERE: �J�/� DATE: � �(3Ia � V ' Notary Public, State ofTexas