Santellana, Stephen - Wilson Contracting, Inc. is_ - ....__._.(LOCAL GOVERNMENT OFFICER CONFLICTS FOR CIS
DISCLOSURE STATEMENT
(Instructions for completing and filing this form are provided on the next page.) q
This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. FFICEU*414Y
1
This is the notice to the appropriate local governmental entity that the following local t
Date Rkeivlid
government officer has become aware of facts that require the officer to file this statement L.L.
in accordance with Chapter 176,Local Government Code. 0
1 Name of Local Government Officer '? y
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C e i I,f L L . 5.S 4 l-`(G't i1 G� > V
2 Office Held U
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3 Name of vendor described by Sections 176.001(7)and 176.003(a), Local Government
Code et)/74/tiA-4,4
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PAP,/
4 Description of the nature and extent each employment or other business relationship and each family relationship
with vendor named in item 3. /
�vr.� ilci 9�Yt,�1. eit 5t1'Nf e / can4S4 y �avvt400-2-1 lei , D t s' L r,.,.i net Ve-k 7'
5 Li gifts accepted by the loaf governmefit officer andny/family rtflember, 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 pert ribed_by Sectio 176.003(a)(2)(B), Local
Government Code.
.�" "'��, DEBORAH NORTON - i tignatufe o4.ocal Government Officer
1'pV PLB'i
_o.- (,_Notary Public,State of Texas
:-.r Comm. Expires 06 20 202Q I:ase complete either option below:
(1)Mk!vh'nn;i °` Notary ID 131612815 t
,
NOTARY STAMP/SEAL
Sworn to and subscribed before me by < , hL
'f S"`{` this the /`1 day of Odi ,
20 a i ,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 8117/2020