HomeMy WebLinkAboutSullivan - ESCI - CIS FormLOCAL GOVERNMENT OFFICER FORM CIS
CONFLICTS DISCLOSURE STATEMENT
(Instructions for completing and filing this form are provided on the next page.)
This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session.
OFFICE USE ONLY
This is the notice to the appropriate local governmental entity that the following local
government officer has become aware of facts that require the officer to file this statement
Date Received
in accordance with Chapter 176, Local Government Code.
RECEIVED
1 Name of Lo al Government Officer
City Secretary
2 Office Held
I- C `\T `/!�� ` e
3 Name of vendor described by Sections 176.001(7) and 176.00i3(a), Local Government Code \
�o ..' � r.-. �� in. r-���-1 � E�� L
rCr^�►i.�r �s � c ..t � CvV1 r� g v� S-��`
4 Description of the nature and extent of each employment or ether business relationship and each family relationship
with vendor nayned in stern 3t J 1� 7.,.'w� Ga ,,� �s.�R +w^"` "�' S., l.�i� •+-,a• `-
- 1 ,, , $ra1 .•-.� :� �- a�.+r�v a
�1-2.A -SuL .Jy.f. :,.� pw�
�$�`
•.i L 9' � c�
r sc-� t' F Y•---. �L', ce. e..�a�,p,�-�. -� IAA so: a,.... A-1-
s List gifts accepted by the local government officer and any family member, if aggregate value of the gifts accepted
from vendor named in item 3 exceeds $100 during the 12-month period described by Section 176.003(a)((22)(13).
Date Gift Accepted 3 Zug °t Description of Gift ryT%,--a, i u-- CnA 5ut- 1 �
Date Gift Accepted S"2'Z-'2011,4% Description of Gift rc--r4z-1-�. LL4 I1Y—V F*+' CIA `5cx— L RoL4 "t �
Date Gift Accepted 6'Z�-Z�gl Description of Gift re.-74.ML JLC. �RA-S°c- �2�1
(attach additional forms as necessary)
61 AFFIDAVIT
I swear under penalty of perjury that the above statement is true and correct. I acknowledge
that the disclosure applies to each family member (as defined by Section 176.001(2), Local
Government Code) of this local government officer. I also acknowledge that this statement
_ .._ veers the 12-month period described by Section 176.003(a)(2)(B), Local Government Code.
";- LINDA RUTH WHITE r
My Notary ID # 124936123
i Expires May 24, 2020
Signature of Local Government Officer
AFFIX NOTARY STAMP / SEAL ABOVE n
w to d su crib before me, by the said this the day
of 20 , to certify w ' , witness my hand and saa of office.
ilY , 6
Sig ture of ofii r administering oath Printed name officer administering oath Title of officer administering oath
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Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015
LOCAL GOVERNMENT OFFICER FORM CIS
CONFLICTS DISCLOSURE STATEMENT
(Instructions for completing and filing this form are provided on the next page.)
This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session.
OFFICE USE ONLY
This is the notice to the appropriate local governmental entity that the following local
government officer has become aware of facts that require the officer to file this statement
Date Received
in accordance with Chapter 176, Local Government Code.
G G
RECEIVED
1 Name of Local Government Officer
pl�v� 5�,11 ✓4a_,
NOV 0 7 2019
City Secretary
2 Office Held ^v
1. i� O�
3 Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government Code
ZF--Le-rVwc--f i5erai' co"'SkW rat [ 1-tiircr't .'ri p .1wA 6E—SC-t'
4 Description of the nature and extent of each employment or other business relationship and each family relationship
with vendor named In item 3.
�o`.-, St~�1;,.a-, '�S p..+�x✓ c0� I�e. .�.a(c L.oc•,\ Go�bc- .—ok .F1
�n
LLCC_� w aV"i c vwF�c.a4� r- csL� ins C'r�A -S/oc_ work ON4�rC
� �QY 4)" a 1�
51 List gifts accepted by the local government officer and any family member, if aggregate value of the gifts accepted
from vendor named in item 3 exceeds $100 during the 12-month period described by Section 176.003(a)(2)(B).
Date Gift Accepted '1-Z1-2ulq Description of Gift M7ti--k LLC- CPA 'SOC-- I�.a�•w..�[
Date Gift Accepted "� ` Gt]1. Description of Gift rC'7h@,A k 1—L C, ;�w, 4 Cf2 A S c `�oclaw«q
Date Gift Accepted. 1't-�'ZOl Description of Gift /`C.u��,LL di•`'��' Svcuoiti
54�
(attach additional forms as necessary)
61 AFFIDAVIT
I swear under penalty of perjury that the above statement is true and correct. I acknowledge
that the disclosure applies to each family member (as defined by Section 176.001(2), Local
Government Code) of this local government officer. I also acknowledge that this statement
s the 12-month period described by Section 176.003(a)(2)(13), Local Government Code.
LINDARUTHWHITE
My Notary ID # 124936123
Expires May24, 2020
u:
_ -- Signature of Local Government Officer
AFFIX NOTARY STAMP / SEAL ABOVE
f ��
6 `
Sw to d su cri before me, by the said this the day
of .20 L� , to certify4hicwitness my hand and seal.
1J1J1A�d11A111y OoLi.
-
Si ature of office administering oath Printed name of vfir.-, administering oath Ti le of officer administering oath
Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015