Wall Street Journal CIQ 03.05.2025CONFLICT OF INTEREST QUESTIONNAIRE . FORM CIQ
For vendor or other Denson doino business with local Eovemmental entitv
This questionnaire reflects changes made to the law by H.B. 23,8/,th Leg., Regular Session.
This questionnaire is being fild in accordance with Chapter 176, Local Govemment Code, by a vendorwho has a business relationship as defined
by Section 176.001(1-a) with a local govemmental entity and the vendor meets requirements under Section 176.006(a) and by Gity of Denton
Ethics Code, Ordinance '18-757.
By law this questionnaire must be filed with lhe records administrator of the local govemment entity not later than the 7tl business day after thr
date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Govemment Code.
A vendor commits an ofbnse if the vendor knowingly violates Section 176.006, Local Govemment Code. An ofiense under this sectilrn is a
misdemeanor.
1 Nare ofvendorwho has a business govenomenhl entity.
Trre "l Sau{d€Doru ( t,rref lu.h///,
Check this box lf you are flllng Jn upCate to a prevlously flted ques0onnalrc.
(The law requies that you file an updated cornplebd qu€stiomairc with the appopriate filing authority not laier than the 7s business day
afrer the date on which you became awar€ that the originallyfiled questionnaire was incomplete or inaccurate.)
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llName of lctal goverummtoffoeraboutwtom the informtioa in thir rectiott ls behg disclosed.
Nameof fficer
Descnte each e,mploymEnt or o&er business relati,onship with tk local gorrermrt officer, or a family me,mber of the officEr, as described by Section
176.003(aX2XA). Also describe any ftmily relations hip with the local govemment officer. This sectioo, (item 3 including subparB A" B, C & D), must be
completed for cach offioor witi whomlhc verdor has m ernployuent or othcrtnrsinesrclationship as defincdby $ection 176.001(1-a),Iocal Gove,tnment Code.
Attach additional pages to this Form CIQ as necessary.
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Is the local govemment offieer named in t[is section receiving or likely to receive taxable income, other tlran invesbnent incgme, from the vendor?E "., lXl*"
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Is the vendor receiving or likely to receive taxable income, other than investment iacooe, from or at the direction of the local govemment officer named in
ttis section AND fre taxable income ir not received &omlhe local govemmental entity?
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Is the filer of &is quesfiornaire enrployed by a corporation or other business e[tity wift mpect to which the local govomment oIficer serres as an officer
or direclor, or holds an ownership ofone percent or reore?
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Describe each employment or business and family relationship wilh &e local govemment officer named in this section,
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4 p t ** no Conflict of lnter€st to dlsclose.