2022-06-13 JOSEPH KOZA CONFLICT DISCLOSURE STATEMENTLOCAL GOVERNMENT OFFICER CONFLICTS
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.
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
in accordance with Chapter 176, Local Government Code.
1 Name of Local Government Officer
2 Office Held
3 Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government
Code
FORM CIS
OFFICE USE ONLY
Date Received
J U N 1 3 2022
CITY OF PEARLAND
CITY SECRETARY'S OFFICE
f""t+N�ER� CAVJ t LS
4 Description of the nature and extent of each employment or other business relationship and each family relationship
with vend r named in item 3.�Q.%C,� 0*0v LBLS 5El&�6 P6fA^'wT i► P�WA %�V�pR,�t,�q�g^�p ctTq
oz
w►.�iD. �q Ilx., �b�t s aaA�. Ropw.T�'jo %CA1J Ls
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), Local
Government Code.
nature of Local Government Officer
Please complete either option below:
LESLIECRITTENDEN
�° - � Notary Public, State of Texas
Commmission Expires
NOTARY STAM Si d } NOTARY ID 13322068.2
Sworn to and subscribed before me by U�'.(���
20 � to certify
of officer administering oath
(2) Unsworn Declaration
My name is
My address is
Executed in
and seal of office,
Printed name of officer administering oath
(street)
County, State of
and my date of birth is
Title of'officer administering oath
(city) (state) (zip code)
on the day of , 20
(year)
(month)
Signature of Local Government Officer
Form provided by Texas Ethics Commission www.ethics.state.tx.us
(country)
eclarant)
Revised 8/17/2020