AD CIS LOCAL GOVERNMENT OFFICER FORM CIS
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. 1491, 80th Leg., Regular Session. OFFICE USE ONLY
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 Date Received
in accordance with Chapter 176, Local Government Code.
1 Name of Local Government Officer
Ap4
2 Office Held
C,rI CcUN -L. Rhea 1
JName of person described by Sections 176.002(a)and 176.003(a), Local Government Code
' { - FAciT5 PI* 1474ti
4J escription of the nature and extent of employment or other business relationship with person named i item 3
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. tom►'► V `�... ,...1.IIiL i..IL ..Av. i ' .,`a!- a —.1 Lt I1a .1
atrt'
5 List gifts accepted by the local government officer a d any family member, excluding gifts desc ibed by Section ,
176.003(a-1), if aggregate value of the gifts accepted from person named in i m 3 exceed$250 during the 12-month
period described by Section 176.003(a)(2)(B) PI tO�]Q►y, C / 7
Date Gift Accepted }j,l/ - Description of Gift ���"� r _ s"/
Date Gift Accepted Description of Gift
Date Gift Accepted Description of Gift
(attach additional forms as necessary)
6I AFFIDAVIT
I swear under penalty of perjury that the above statement is true and correct. I acknowledge
that the disclosure applies to a family mem.."(as defined by Section 176.001(2), Local
Government Code) of this local governm:.offic . I also nowledge that this statement
co ers the 12-month period describe. .y ' n •. (a), I Government Code.
40.1%.� /
CHRISTEL 8 PETTINOS p �
My Commission Expires
May 10. 2015 / /,: Signature of Local Government Officer
AFFIX NOTARY STAMP / SEAL ABOVE //�
Sworn t•and subscribed before me,by the said Thew C 4-i- this the c y day
of .1 a _, ,,20 / 7, ,to certify which,witness my hand and seal of office. 1
' i _ _,W41# ...-01,
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Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath
Adopted 06/29/2007