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Toodgood, David 10.14.2025 LOCAL GOVERNMENT OFFICER CONFLICTS FORM CIS 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 CAW 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 Recei ed '" in accordance with Chapter 176, Local Government Code. cu E 1 Name of Local Government Officer V ►= Dak.icj " (1)06-401> ,?.i 2 Office Held 3 sr 7 I,J t C -I I'r!� -Ac.1-5 Ec©Now�,c, m r 3 Name of vendor described by Sections 176.001(7)and 176.003(a), Local Government U '— Code Ca c t OSC\ W I(-141 t'A 1Q,1I 5 2 c crC) n rri 4 Description of the nature and extent of each employment or other business relationship and each family relations lip with vendo named in item 3. Cra 6 wSc-- CNaN-c'r cF17) wi4c PeavIJCS 3AN,TogIAL- SCRvi&'S 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 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 period described by Section 176.003(a)(2)(B), L cal Government Code. G3o "'"""` Signature of Local Govern t Officer �wY'a; MARIE BALTHROP �� 0\Notary Public.State of Texas ( My Commission Expires Please complete either option below: .`k,, :,, October 26,2027 p p • NOTARY ID 11738621 (1)A laavtr- - —' NOTARY STAMP/SEAL /� T (j �y�(, Sworn to and subscribed before me by Da4J t ' oojood this the /1 day of D(/7(JUer , 20 , to certify which,witness my hand and seal of office. 4a.u;, Ra- Mane e"'I r°I° CAj Utirk 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