Church of Pentecost CIQ 08.05.2025CONFLICT OF INTEREST QUESTIONNAIRE - FORM CIQ
For vendor or other person doing business with local governmental entity
This questionnaire reflects changes matte to the law by H.B. 23, 84th Leg., Regular Session.
This questionnaire is being fled in accordance with Chapter 176, Local Government Code, by a vendor who has a business relationship as defined
by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a) and by City of Denton
Ethics Code, Ordinance 18-757.
By law this questionnaire must be filed with the records administrator 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 fled. 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
misdemeanor.
d
Nam of vendor who has a business relationship with local governmental entity.
2 Check this box if you are filing an update to a previously filed questionnaire.
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(The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 70 business day
after the date on which you became aware that the originally tiled questionnaire was incomplete or inaccurate.)
3 Name of local government officer about whom the information in this section is being disclosed. ..
Name of Officer
Describe each employment or other business relationship with the local government officer, or a family member of the officer, as described by Section
176.003(a)(2)(A). Also describe any family relations hip with the local government officer. This section, (item 3 including subparts A, B, C & D), must be
completed for cub officer with whom the vendor ham employment or other business relationship as defined by Section 176.00If Ia), Local Govemment Code.
Attach additional pages to this Form C[Q as necessary.
A. Is the local ovemment officer named in this section receiving or likely to receive taxable income, other than investment income, from the vendor?
Yes O No
B. Is the vendor receiving or likely to receive taxable income, other Wan investment income, from or at the direction of the local government officer named in
this section AND the taxable income is not received from the local governmental entity?
El Yes 10 No
C. Is the filer ofthis questionnaire employed by a corporation or other business entity with respect to which the local government officer serves as an ofTtcer
or director, or bolds an ownership of one percent or rare?
Yes P No
D. Describe each employment or business and firmly relationship with the local government officer named in this section.
4
t v t `have no Conflict of Interest 13 disclose.
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