Turn Compost CIQ 7.1.22a questionnaire is bang fled in sco rdance with Chapter 176, Local Government Code, by a vendor who has a business relationship as de
Section 1]8.001(1-a) with a local gmemmenlal entity and the warder meets requirements under Section l7G.0o6(o) and by City of Derr
'a Codes, Ordinance 18-757,
law Mas questionnaire most be filed with Me records administrator of the local gmemntent entity not later than Me 7th business day aM1
a Me vendor becomes aware of facts that require Me statement to be filed. See Section 176.008(a-1), Local Gavemment Code.
vendor commits an offense if the vendor knowingly violates Section 176.006, Loral Gavemment Cotle. M otlerme on or Me sectir
❑ CMck lMs box H you aro flllrrg en uptlale toe farevlaualyflptl quesllonrwlro.
frhe law reculres that you file an undated correlated auestionnalre with Me apprOPOWe fling authonty not later than Me 7" business
\vme of b<a1 gmemmmt oflkev ebaur xbom Me Infvwetlov Iv shts tt<rbv fi belvy dls<leaed.
Name of Officer
IXsoibs cods mrplonnmr mothm Wsiuess rebtiou.hip ssiMMe t«at gosmmm<officec, mafioWymmnbmof Hrc of5cm. as descnlsdby6ecUw
116003(aM-xa.). Also hsrnbe aey farwlYrclvtims M1iP xiM tb<local Ro•mwmf o6iw.'Ibis mnvn(item 3'vWdmR mhpuesABC&D).. most tz
Aaach ad fmm eacM1 offices weq fone nIQ snxbchm ®mnplayumtoroWmbushrmarcbdamM1p ae de5vd by 6<miov Ith.001(t-al. C«a1 Gmmunmr C.
Ardchaddificval (vges ro chis Form CIQ as necessary.
A f. Me local gosntmmn oBcc avud in Mia s<ewe re ,nog m life"gecose hoosb1c mrum<, other them invesmms income. from the mdm`
O , ONo
H. Is the seoiof recehing cr Itely ro receise taxable income. odmr then imesnnml acome.fr«n or at the dirccnon of Me Ical ane ut officer vomer
this. bon Mm Me taxable incense is trot received frmn Me local xmemmmtal entity?
O Yen O No
C Is the fila ofthis gnesnosmzcC ryloyd by a corymetioo oratber bUnewe mrfitywith respect to xtichtbe local gosmlmmt offcer gimes assn offic
m director. an holda an msvrnhip ofosse ps:mmt or mrc'
I have no Conflict of IMeteat b dlaclose.
%!cm ('nry�dsr; LGG �uAi.r / ynzz