Santellana, Stephen - Bowles Construction LOCAL GOVERNMENT OFFICER CONFLICTS FOR IS
DISCLOSURE STATEMENT
(Instructions for completing and filing this form are provided on the next page.) y
This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFilCE USE 1:0N,01'I
This is the notice to the appropriate local governmental entity that the following local Date Recei ed w L..government officer has become aware of facts that require the officer to file this statement V F"
in accordance with Chapter 176,Local Government Code. ±
O
1 Name of Local Government Officer
k.&1 L. �I( Z Y a rxi� a��r� w cc o
2 Office Held > U --,
3 Name of vendoriascribed by Sections 176.001(7)and 176.003(a), Local Government CC 0 o m
Code i
Bat) /IS CV il 5411.!/47.01
4 Description of the nature and extent of each employment or other business relationship and each family relationship
�//with vendor named in item 3. p /f
P'tQ,Noi S `Ji wiy c-&tJ getil Le, ['Ue et,rl.i Jog L �-t- -4V— tfes.Lit)4
5 Lidt gifts acceibtdd by the local government oificer4nd 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 SIGNATURE 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 p • licribed by S 176.003(a)(2)(B),Local
Government Code.
tignatur(dFL'ocal Government Officer
�,uni
to
.f\ PU�ii DEBORAH NORTCIr'
:: Notary Public,State of Please complete either option below:
�9 .•+;c Comm. Expires 06-2G-
(1) a � „�� Notary ID 13161281
NOTARY STAMP/SEAL // I
Sworn to and subscribed before me by .S�b� 5 k/L this the / VI'2.- day of e9 L'' ,
20 a( ,to certify which,witness my hand and seal of office.
Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath
OR
(2)Unsworn Declaration
My name is , and my date of birth is .
My address is , , •
(street) (city) (state) (zip code) (country)
Executed in County,State of ,on the day of ,20 .
(month) (year)
Signature of Local Government Officer (Declarant)
Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020