Browning, Jeff 07.18.2018LOCAL 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.
-L
1 Name
of Local Government Officer
Jeff Browningrn
n
D
m
2 Office Held
m n
City of Wichita Falls, Councilor District 3
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3 Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government Code
C� n
Browning Electric 0t1
4 Description of the nature and extent of each employment or other business relationship and each f ily relationship
ownd rgna� e�iCr1iriinc, (Owned by Jeff Browning) has provided electrical
service repairs when requested for the past 11 years at the MPEC, which
is located at 1000 5th Street, Wichita Falls, TX 76301.
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 Description of Gift
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
r•+4�pvo •w NIKKI LAB ERNATHY covers the 12-month period described by Section 176.003(a)(2)(B), Local Government Code.
Notary Public, State of Texas
"• Notary ID 9130i9730-6
aNr�.yr
.,+ •... + MY Commission Expim
'"° �••"• August 26, 2020
P.M
Si ure of Local7G.vernment Officer
AFFIX NOTARY STAMP SEAL ABOVE �� r
Sworn to 1 /� / /�
before �
and subscribed me, b the said
y _�„! V V"_ l � ,this the day
/
of 20 , to certify which, witness my hand and seal of office.
Si rfat of f 'Der administering oath Printed name of officer administeriA oath Title of officer administering oath
Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015