HomeMy WebLinkAbout20250725 Joseph Koza Conflict Disclosurer
LOCAL 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
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3 Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government
Code
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4 Description of the nature and extent of each employment or other business relationship and each family relationship
with vendor n med in POitem 3. E ic_,a M �pe�.c 5 L1ct, l6 ‘-r la PM i jtki OA vk� C Ca�� 1J t, L z 5 ' A c O Vficc4 Mc, ocitt OALL0
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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 Received
FORM CIS
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Date Gift Accepted
Date Gift Accepted
Date Gift Accepted
Description of Gift
Description of Gift
Description of Gift
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.
(1) Affida
NOTAR
Terris Flora
My Commission Expires
11/22/2027
Notary ID 124044738
Sworn to ar subscribed before me by
20 to certify w lotess m ..hatid and seal of o
ignature of Local Government Officer
ase complete either option below:
Signature of officer administering oath
this the
Printed name of officer administering oath Title of officer administering oath
OR
(2) Unsworn Declaration
My name is , and my date of birth is
My address is
(street)
Executed in County, State of
Form provided by Texas Ethics Commission
(city) (state) (zip code) (country)
, on the day of , 20
(month) (year)
Signature of Local Government Officer (Declarant)
•
•
1
www.ethics.state.tx.us
Revised 8/17/2020