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Conflict of Interest

  1. Check this box if you are filing an update to a previously filed questionnaire:

    The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.

  2. Is the local government officer or a family member of the officer receiving or likely to receive taxable income, other than investment income, from the vendor?*
  3. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer or a family member of the officer, and the taxable income is not received from the local governmental entity?*
  4. Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1):
  5. Leave This Blank:

  6. This field is not part of the form submission.