HomeMy WebLinkAboutMark Alphonso - Financial (2)City of Colleyville Financial Disclosure and Business Conflict of Interest Forms
INFORMATION STATEMENT
TOTAL NUMBER OF PAGES FILED:
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OFFICE USE ONLY
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° REASON 0 EMPLOYEE (CITY MANAGER OR *SENIOR STAFF)
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❑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.
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COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY
INITIAL HERE: S�" DATE: � �3 �`�
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 FILER SPOUSE DEPENDENT CHILD #�
Z DESCRIPTION
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STREET ADDRESS STREET ADDRESS, INCLUDING CITY, COUNTY, AND STATE
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° NAME LIST THE NAMES AND ADDRESSES OF OTHER PERSONS OR
BUSINESS ENTITIES WHICH OWN AN INTEREST IN THE REAL
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4 NAME LIST THE NAMES AND ADDRESSES OF OTHER PERSONS OR
BUSINESS ENTITIES WHICH OWN AN INTEREST IN THE REAL
PROPERATY
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COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY
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❑ NOT APPLICABLE INITIAL HERE:_� DATE: �/3�f y
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 OFILER OSPOUSE ODEPENDENT CHILD #_
ZFEE, SALARY, GIFT NAME AND ADDRESS
3 DESCRIPTION OF FEE,
SALARY, GIFT
1 RECIPIENT OFILER OSPOUSE ODEPENDENT CHILD #_
Z FEE, SALARY, GIFT NAME AND ADDRESS
DESCRIPTION OF FEE,
SALARY, GIFT
1RECIPIENT 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: 6I�3Ia�
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 OSPOUSE ODEPENDENT CHILD #_
Z DESCRIPTION NAME AND ADDRESS
3 NATURE OF BUSINESS
' HELD OR ACQUIRED BY OFILER OSPOUSE �DEPENDENT CHILD #_
2 DESCRIPTION NAME AND ADDRESS
3 NATURE OF BUSINESS
1 HELD OR ACQUIRED BY OFILER �SPOUSE ODEPENDENT CHILD #_
Z DESCRIPTION NAME AND ADDRESS
3 NATURE OF BUSINESS
COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY
�NOT APPLICABLE INITIAL HERE:� DATE: % I3 2y
City of Colleyville Financial Disclosure and Business Conflict of Interest Forms
PERSONAL FINANCIAL STATEMENT
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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:
�1�Q,�. � who, after being duly sworn upon their
oath and deposed and stated as follows:
"My name is o,�l� ,��i��^�+�4o 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
that has been withheld
disclosed by the forms."
contained in the forms is complete. There is no information
or not disclosed which is responsive to or required to be
Affiant
Sworn to and subscribed before me, this the � day of �LL/lG �- , 200��
i�.ax�►�rr�
JUN 1 � 2024
�°i�� ��crc;�ary°� pifec�
INITIAL HERE: I�— DATE: �'(3��t c/
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Notary Public, State of Texas