HomeMy WebLinkAboutTiburon Lockers, Inc. 2023illimi; ir i� �;iq �!: �ri
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This questionnaire reflects changes made to the law by H.B. 23, 84th Log., Regular Session.
This questionnaire is being filed in accordance with Chaplet 176, Local Government Code. by a vendor who
has a business relationship as defined by .Section 176.001(1 -a) with a local governmental entity and the
vendor rneets requirements under Section 176.006 i).
By law this questionnaire must be tied with the records administrator of the local governmental entity not later
titan the 7th business day after the date he vendor becomes aware of facts that require be statement to be
Zed. Soo section 176.0064a -1), Local Governmont Code,
A vendor cornmits an offense if the vendor knowingly violates Section 176.006; Local Government Code, An
offense under this section is a misdemeanor,
Name oll vendor who has abusliness relationship with local governmental entity.
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Date Recarved
Check this box if you are filing an u� date to a previously filed questionnaire. !The law requires that you file an updated
completed questionnaire with the appropriate filing authority not later than the 7th business day after the date an which
you became aware that the originally filed questionnaire was incomplete or inaccurate)
Name of local government officer about whom the information is being disclosed,
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Name of Officer
Describe each employment or other Wetness relationship with the local government officer, or a family member of the
officer, as described by Section 176,003(a)(2)(A), Also describe any family relationship with the loco] goverment officer.
Complete subpau A and 8 for each employment or business relationshillodescribed. Attach aidditional pages to this Form
010 as necessary.
A. Is the local government officer or a tarnily member of the officer receiving or likely to receive taxable income,
other than investment income, from the vendor?
L-1
Yes No
e. Is the vendor receiving or likely to receive taxable income, other than investment incorne, from or at the direction
of the local government officer era family member of the officer AND the taxable income is not received from the
local governmental entity?
0 Yes E71 No
Describe each employment or business relationship thatthe vendor named in Section I maintains with a corporation or
other buismOSS entity With respect to which the local goverminent officer serves as an officer or director, or holds an
ow neiship interest of one peircem, or more.
Check thi&box if the vendor has given the local Uov4mment officer or alamily member of the officer one or more gifts
as described in Section 176,003(e)(2)iP), excluding gifts described in Section 176.003(a-1).
It 130 /2923
O'FVQ;-dor doing GZM'riess Mth 019 government entity Date
Form provided by texas Elhics, 901nmission vowwe thics. state tx Liz Revised I I P$QIZO I
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