HomeMy WebLinkAboutUntitled (6) LOCAL GOVERNMENT OFFICER CONFLICTS FORM CIS
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. OFFICE USE ONLY 1
This is the notice to the appropriate local governmental entity that the following local
Date Received
government officer has become aware of facts that require the officer to file this statement
in accordance with Chapter 176,Local Government Code. 3�P.•.
1 Name of Local Government Officer
Tito Rodriguez RECEIVED
2 Office Held f� G LJ
City of North Richland Hills Mayor Pro Tern MAY 3 0 1023 cq
3 Name of vendor described by Sections 176.001(7)and 176.003(a), Local Government CITY SECRETARY
Code
Texas Municipal League
4 Description of the nature and extent of each employment or other business relationship and each family relationship
with vendor named in item 3.
Mr. Rodriguez is the current president-elect of the Texas Municipal League.
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 Gift Accepted 5/23/23 Description of Gift $1,155.24-NLC Conference,Washinton, DC Mar 11-13,2023(travel)
Date Gift Accepted 5/23/23 Description of Gift $375.92-Southern Municipal Conference,San Antonio Mar 12-14,2023(travel)
Date Gift Accepted 5/23/23 Description of Gift $375.42-Small Town Conference, Bastrop,May 10-12,2023(travel)
(attach additional forms as necessary)
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. ;''� •
+* TRAaHENDERS01`1 Signature of Local ternment Officer
• *`• My Notary ID It125381736
`,• •�F KE;;j Sepbefrlber 12,2025 Please complete either option below:
NOTARY STAMP/SEAL
Sworn to and subscribed before me by 1776 7 la igu ez this the ,...30‘ day of
20 23 ,to certify which,witness my hand and seal of office.
� .. •- t "Qz":_llenefe h /J r y
Signature of officer administering oath Printed name of officer administering oath Title of officeredfninistering oath
OR
(2) Unsworn Declaration
My name is , and my date of birth is
My address is , ,
(street) (city) (state) (zip code) (country)
Executed in County,State of ,on the day of ,20
(month) (year)
Signature of Local Government Officer(Declarant)
Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020
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