Reeves, James 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
• 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.
1 Name of Local Government Officer
07/2`0doZr
2 Office Held
POLECF. OFFi /�Ro
3 Name of vendor described by Section176.001(7)and 176.003(a),Local Government
Code ��J (4-SSOQI:a-r-073
XI)s6'bLLc - CiZS
4 Description of the nature and extent of each employment or other business relationship and each family relationship
with vendor named in item 3. ,,�,,n
-FijiZ %�� P,� 1�CJ 11
5 List gifts accepted by the loca I 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 itJ A . Description of Gift N[ii
`
Date Gift Accepted Description of Gift
•
Date Gift Accepted Description of Gift
(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 .003(a)(2)(B),Local
```tt„Ili t l t Rpvernment Code.
\``‘p.�RA...... Sj''e., Signature of Local Government Officer
v,...0 Y pie`%-7
Please complete either option below:
N
(1)Afaat ; y Pc
�x-o.•. t of S�� 4o
NOTAf t6•'O
1/ �'vAR`( � ``•` p J r
Sworn to and s�6l;t7itnof t bt?'Fbre me by i /) • the•(�-L)e c this the 2 3 day of - t,7 ,
20 ce�tity�yhich,witness my hand an seal
se�al�of office. [/� //y /)
(�.!'� l/.il / �, ap.-- /T�CuIIo/k•-- -CCI s .�')1�lyt1 4—
Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath
OR
(2)Unswom 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