Lee, Andy 04.24.2018 (2 included)LOCAL GOVERNMENT OFFICER FORM CIS
CONFLICTS DISCLOSURE STATEMENT
(instructions for completing and filing this form are provided on the next page.)
This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY
This is the notice to the appropriate local governmental entity that the following local
government officer has become aware of facts that require the officer to file this statement Date Received
in accordance with Chapter 176, Local Government Code. co
1 Name of Local Government Officer
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2 Office Held
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3 Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government Code
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4 Description of the nature and extent of each employment or other business relationship and each family relationship
with vendor named in item��3-.
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5 List gifts accepted by the local government officer and any family member, if aggregate value of the gifts accepted
from vendor named in item 3 exceeds $100 during the 12-month period described by Section 176.003(a)(2)(B).
Date Gift Accepted! /S �� Description of Gift ��~YyL T �,�/ S!�K�«4�
Date Gift Accepted Description of Gift
Date Gift Accepted Description of Gift
(attach additional forms as necessary)
6 AFFIDAVIT
I swear under penalty of perjury that the above statement is true and correct. I acknowledge
that the disclosure applies to each family member (as defined by Section 176.001(2), Local
Government Code) of this local government officer. I also acknowledge that this statement
•'7. overs the 12-month period described by Section 176.003(a)(2)(B), Local Government Code.
rq•-; KIA BOONE
y= My Notary ID # 131047080
Expires March 15, 2021 �� G
Signature of Local Government Officer
AFFIX NOTARY STAMP / SEAL ABOVE
Sworn to and subscribed before me, by the said this the 12 � t JA day
ofif� 1 20 _ tIc_ , to certify which, witness my hand and seal of office.
Signature of off r administering oath Printed name of officer a inistering oath Title of offi er administering oath
Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015
LOCAL GOVERNMENT OFFICER FORM CIS
CONFLICTS DISCLOSURE STATEMENT
(Instructions for completing and filing this form are provided on the next page.)
This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY
This is the notice to the appropriate local governmental entity that the following local
government officer has become aware of facts that require the officer to file this statement Date Received
in accordance with Chapter 176, Local Government Code.
1 Name of Local Government OfficerW�
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z Office Held M 0 m
mo
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3 Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government Code -r1 Z
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4 Description of the nature and extent of each employment or other business relationship and each f mily relationship
with vendor named in item 3.
5 List gifts accepted by the local government officer and any family member, if aggregate value of the gifts accepted
from vendor named in item 3 exceeds $100 during the 12-month period described by Section 176.003(a)(2)(B).
Date Gift Accepted 17 Description of Gift
Date Gift Accepted ll �� Description of Gift '-^'Nsv�' �iJ✓ r`E=C
Date Gift Accepted Description of Gift
(attach additional forms as necessary)
6 AFFIDAVIT
I swear under penalty of perjury that the above statement is true and correct. I acknowledge
that the disclosure applies to each family member (as defined by Section 176.001(2), Local
Government Code) of this local government officer. I also acknowledge that this statement
covers the 12-month period described by Section 176.003(a)(2)(B), Local Government Code.
" 't'Ir� •, KIA BOONE
My Notary ID # 131047080
Expires March 15, 2021
S' al of Local Government Officer
AFFIX NOTARY STAMP / SEAL ABOVE
Sworn to and subscribed before me, by the said this the v2 y1 A day
of r1 1 , 20 , to certify which, witness my hand and seal of office.
� rt
Signature of offer administering oath Printed name of officer administering oath Title of o ficer administering oath
Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015