MS Lewisville LLC CIQ 12.23.25CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ For vendor or other erson doln business with local overnmental entlt
This questionnaire reflects changes made to the law by H.B. 23, 8,tth Leg., Regular Session.
This questionnaire Is being filed in accordance with Chapter 176, Local Government Coda, by a vendor who has a business relationship as define by Section 176.001(1-a) with a local governmental anUty and the vendor meets requirements under Section 176.006(a). By law this questionnaire must be filed with the records administrator of the local government entity not later than the 7th business day after It date the vendor becomes aware of facts that require the statement to be filed. Sae Section 176.006(&• 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 misdemeanor.
1 Name of vendor who hH a bualnaaa relatlonahlp with local govemmental entity.
2 □ Check thla box If you are filing an update to a prevloualy filed quaatlonnalre.
(The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the .,.,, business day after the data on which you became aware that the origlnaly filed quastiOMalre was Incomplete or Inaccurate.) 3 Name ol loc:al covernment officer ■bout whom the lllform1doo ID tbb 1ttdoo Is bel111 dlsc:losed.
Name of Officer
Dcscnbe cai:h employment or other businen relationship wtth the local government officer, or I family member of the officer, u de5cnbcd by Scc:uon I 76.003(a)(2)(A). Also describe any family relations hip with the local government officer. This section, (item 3 including subparts A, B, C & D), naist be completed for each officer with whom the vendor has an employment or other busincss relationship as defined by Section 176.00 I ( J-1), Local Govcmment Code. Auach additional pages 10 this Fonn CIQ ■s necessary.
A.Is the local government officer named m this section rcceivmg or likely to receive taxable 111come, other than investment income. from the vendor?D VC$ DNo
8.ls the YCndot-receiving or hkely to rcc:c1ve taxable income, other than investment income, from or at the dJrcc11on of lite loc:.I government officer named inthis section AND the taxable income is not n:ecivcd from the loc:.1 governmental entity? D Yes DNo
C Is the filer of this questionnaire employed by I corporation or other business entity with respect 10 which the local government officer scn'CS as an officer or director, or holds an ownership of one percent or more? □No
D Descnbc each employment or business and family rcl111onship wuh the loc:.I government officer named in this secllon
◄ e I have no Conflict of lntereat to dlsclOH.
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