HomeMy WebLinkAbout20250728 Joseph Koza Conflict DisclosureLOCAL GOVERNMENT OFFICER CONFLICTS
DISCLOSURE STATEMENT FORM CIS
(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, 80th Lag., Regular Session.
This is the notice to the appropriate local governmental entity that the following local
OFFICE USE ONLY
government officer has become aware of facts that require the officerto file this statement
Dale Received
in accordance with Chapter 176, Local Government Code.
RECEIVED
I Name of Local Government Officer
3SEPA C.
JUL 28, 2025 14:58
CITY OF PEARLAND
2 office Hold
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ITYOFFICE
3 Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government
Code
4 Deaerlptlan of the nature and extent of each empployment ofJ, her business relationship and each family relationship
with vendor named in Item 3. 1' dCCa4 $E..c5 NSP.e.c other
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6 LIst gills accepted by the local government officer and any family member, it 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).
Dale 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 penally 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. 1
also acknowledge that this statement covers the 12 -month period described n 176.003(a)(2)(8), Local
Government Coda.
Sign a of Local Government Officer
Tarde Flora
My commlµlon Expina lease complete either option below:
111222027
(i)A Notary 1D1/240µ738
NOTARY STAMP! SEAL
Sworn to a .substbed before me by J OI32 I') K.Otw this the 29'day of5
20 ,tocedifywhich.vMnessmyha ofseal�fy{asw-- �� Pb
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P rC b)
signature f officer administering oath Printed name of officer administering oath Title of officer administering oath
(2) Unsworn Declaration
My name is and my data of birth Is
My address Is
(asset) (city) (Nate) (zip code) (country)
Executed in County, State of the
, on _ day of 20
(month) (year)
Signature of Local Government Officer (Dedarant)
Form provided by Texas Ethics Cnmmlecme __.. _..._.
Revised 8/17/2020