CONFLICT OF INTEREST QUESTIONNAIRE

For vendor or other person doing business with local governmental entity

This questionnaire is being filed in accordance with chapter 176 of the Local Government Code by a person doing business with the governmental entity.

By law this questionnaire must be filed with the records administrator of the local government not later than the 7th business day after the date the person becomes aware of facts that require the statement to be filed. See Section 176.006, Local Government Code.

A person commits an offense if the person violates Section 176.006, Local Government Code. An offense under this section is a Class C misdemeanor.

Date Received

              Walsh, Anderson, Brown, Schulze & Aldridge, P. C.

                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 September 1 of the year for which an activity described in Section 176.006(a),

                        Local Government Code, is pending and not later than the 7th business day after the date the

                        originally filed questionnaire becomes incomplete or inaccurate.)

               Describe each affiliation or business relationship with an employee or contractor of the local

               governmental entity who makes recommendations to a local government officer of the local

               governmental entity with respect to expenditure of money.

             NONE

               Describe each affiliation or business relationship with a person who is a local government officer and who

               appoints or employs a local government officer of the local governmental entity that is the subject of this

               questionnaire.

           NONE

CONFLICT OF INTEREST QUESTIONNAIRE

For vendor or other person doing business with local governmental entity

         Name of local government officer with whom filer has affiliation or business relationship. (Complete

         this section only if  The answer to A, B, or C is YES.)

       
        This section, item 5 including subparts A, B, C & D, must be completed for each officer with whom the filer has
          affiliation or business relationship. Attach additional pages to this Form CIQ as necessary.

A.       Is the local government officer named in this section receiving or likely to receive taxable income from the

        filer of the  questionnaire?

                                           Yes            XX           No

B.       Is the filer of the questionnaire receiving or likely to receive taxable income from or at the direction of

        the local government officer named in this section AND the taxable income is not from the local

        governmental entity

                                            Yes            XX           No

C.      Is the filer of this questionnaire affiliated with a corporation or other business entity that the local

        government officer serve as an officer or director, or holds an ownership of 10 percent or more?

                                              Yes             XX         No

          D. Describe each affiliation or business relationship.

            NONE
 

         

                Describe any other affiliation or business relationship that might cause a conflict of interest.

            NONE