2024-08-26 Joseph KozaL CAL VERKIMEMT FRICE CONIFRIICTS
NISCIL SU E STATEMENT
(Instructions for completing and filing this form are provided on the next page
F Han CIE
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.
I Name of Local Government Officer
JaS6PA C.(s. NRcruk
office Held
Ca ` t er Stub Cvr Cootact Posen
3 Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government
Code
OFFICE USE NLV
Date Received
RECEIVED
MG 2 r 2 n u
Gilt; or .PLABLAND
CITY 8FCP.i A gP13O_F
Description of the nature and Went of each em 1 yment or other business relationship and each family lationship
with vendor namedInCE ��5 � i vk&cr � P t To
item 3. t ��� �� rke Cite./ ra��p
t4ia Lct. 5Eusfligt4 5asts fhamervk 00,ALrA%J€CQP T»
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)(S).
Date Gift Accepted Description of Gift
Date Gift Accepted Description of Gift
Date Gift Accepted Description of Gift
(attach additional forms as necessary)
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.
se-cat—
(1)Afi
Terrie Flora
My Commission Expires
11/22/2027
Notary ID 124044738
NOTARY STAMP/SEAL
Sworn to an
subscribed before me by
20 ,t
Signature
Signature of Local Government Officer
Please complete either option below:
rtify which, witness my hand ands ice.
1( i1..ei (3\e- s--
fficer administering oath
Printed name of officer administering oath
this the
Lico 1447
PviloI Qt.,
esk
itle of officer administering o
OR
(2) Unsworn Declaration
My name is , and my date of birth is
My Address is
Executed in
(street)
- County, State of
•
(city) (state) (zip Pods) (sAuntry)
- - , on the - --clay of _._ - - _ -- _ ., 20._
(month) tyeiTO
SIgnature ut Loedl tuvettiti1@fit °t#ieer (boeldratit)
.
Form provided by Texas Ethics Commission
www.ethics.state.tx.us Revised 8/17/2020