1 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 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 state in accordance with Chapter 176, LOCAL GOVERNMENT Code. ij Na e of LOCAL GOVERNMENT OFFICER KCEIVED. Htn _ Date Received I. As Ioi P n AUd,06 2018. E Office Held Board of Trustees Katy ISD. o Tc) Trus s ro5. 3 | Name of vendor described by Sections (7) and (a), LOCAL GOVERNMENT Code NA.
2 Tf Description of the nature and extent of each employment or other business relationship and each family relationship ith vendor named in item 3. NA. 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- onth period described by Section (a)(2)(B). Date Gift Accepted, Description of Gift. Date Gift Accepted, Description of Gift. Date Gift Accepted, Description of Gift. (attach additional forms as necessar ). 3" AFFID VIT. I swear under penalty of perjury lhat the abo e statement is true and correct. I acknowledge x \\\0'"lllb////. that the disclosure applies to each family member (as defined by (2)l LOCAL GOVERNMENT Code) of this Icfcal GOVERNMENT OFFICER .
3 Latso acknowledge lhat this statement covers the 12-month period pscribed by Secti9rr1 o\003(a)(2)(B), LOCAL Go enjment Code. ; 1. ' IbJ OF. 03-26. AFFIX NOTARY 'SWMlP'7 SEAL ABOVE. Sworn to and subscribed before me, by the said this the TVt- day _. 20.., to certify which, witness my hand and seal of office. uic eue D c s Signature oTofficer administering oath Printed name of OFFICER administering oath Form provided by Texas Ethics Commission Revised 11/30/2015.