2023-10-03_TONY CARBONE_CONFLICT DISCLOSURE STATEMENTLOCAL GOVERNMENT OFFICER FORM CIS
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.
OFFICE USE ONLY 1
Date Received
JName
of Local Government Officer
Piliy . CI1R�0,i�--
J
Office Held
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erpo".:1
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2.1
Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government Code
1sCtr kit B4rLey , L4/
LI
firi
Description of the
with vendor named
f'vt, ` C0t4t0(
nature and extent of each employment or other business relationship and each family relationship
in item 3.
A cis l eut lr..11 361•+ty C,,- pde,470w ,E y, __ '7j':
J
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
A
(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 government officer. I also acknowledge that this statement
o`ppvaU.'.,, WANDA BARNETT
_` %Notary Public, State of Texas
-: e
covers the 12-month period dd by Section 176.003(a)(2)(B), Local Government Code.
.. 'v Comm. Expires 06-06-2025
n,,,,,,r Notary ID 128634940
Signature of Local Government Officer
AFFIX NOTARY STAMP / SEAL ABOVE C11
Sworn to and subscribed before me, by the said Ts h..l Ct bone , this the day
of 0--*Dber , 20 0•• , to certify which, witness my hand and seal of office.
w o ?"J &t>f to 13arratt notelry
Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath
Form provided by Texas Ethics Commission
www.ethics.state.tx.us
Revised 11/30/2015