2021-01-05 HERNANDEZ, ADRIAN CONFLICT DISCLOSURE STATEMENT LOCAL GOVERNMENT OFFICER FORM CIS
CONFLICTS DISCLOSURE STATEMENT
(Instructions for completing and filing this form are provided on the next page.)
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This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY
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 Received
in accordance with Chapter 176,Local Government Code.
Name of Local Government Officer
Adrian Michael Hernandez
11 Office Held
Pearland City Council Position 4
•
11 Name of vendor described by Sections 176.001(7)and 176.003(a), Local Government Code
Keep Pearland Beautiful
LI Description of the nature and extent of each employment or other business relationship and each family relationship
with vendor named in item 3.
Vendor is Officerholder's primary employer.
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$100 during the 12-month period described by Section 176.003(a)(2)(B).
Date Gift Accepted Description of Gift
Date Gift Accepted Description of Gift
Date Gift Accepted Description of Gift
(attach additional forms as necessary)
II AFFIDAVIT
I swear under penalty of perjury that the above statement is true and correct. I acknowledge
that the disclosure applies to each family member(as defined by Section 176.001(2), Local
Government Code) of this local�govve oten/gri a. acknowledge that this statement
covers the 12-month period riE' bed by Section 176.003(a) ), Local Government Code.
ignature ocal Government Officer
AFFIX NOTARY STAMP / SEAL ABOVE
Sworn t and subscribed before me,by the said dgi 0..It PrierNm4C2-- this the day
o ,'20 al ,to certify which,witn s my hand and seal of office.
ignature of officer administering oath Printed time of officer administering oath Title 4 .$teri4Liy
er`administering oath
Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015