Anchortex Corp CIQ 1.24.23CONFLICT OF INTEREST QUESTIONNAIRE
This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendorwho has a business relationship as definedby Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a)
By law this quesiionnaire must be filed with the records admrnistrator of the local government entity not later than the 7th business day after the
date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code.
A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a
mtsdemeanor.
Name of vendor who has a business relationship with local governmental entity.
*io
n Check this box if you are filing an update to a previously filed questionnaire.
(The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7'n business day
after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.)
Name of local government olllccr about rvhorn flrc infolmltion inthis scction is hcing disclosed.
il\fr
Name of Officer
Describeeaclrernploylrrerrtorotherbusinessre1ations1ripwiththeIocaIgovertinretrtoffcer,orafanrily
176.003(a)(2)(A). Alsodescribeanyf'arnilyrelationshiprvithtlielocal governurentofficer. Thissection,(item3includingsubpartsA.B,C&D).mustbe
coInpletedforeacho|fcerwit1ru4-ronrthevendor1ras
Attach additional pages to this Forn CIQ as necessary.
A. Is the loca officer named in this section receiving or likelv to receive taxable income. other thau investlnenl income, liorn tl-re venclor?
[*f *o
lstlrevendorleceivingorlikelytoreceivetaxableitrcotrte'otlrertlranitrl,esttnerrt
this section AND the taxable inconre is not received Ii'om the Iocal governmental entitv?
il*o
Isthe1,ilerofthisquestionriaireenlplovedbyaoorporationorotlrerbLlsitresserrtitywith
or director. or holds an or,vnership ofone percent or mofe'/
l-*l
"",
il*o
Describe each employniemt or business and family relationship with tlie local govemment officer named in this section,
I have no Conflict of Interest to disclose.
*1
I governnient
l--l ".,
--MJ:{W---Signature ofvenclor doing busirress with the governnental elttity
I
i
II
I
I