2023 Gorgone SOPA THE CITY OF
COPPELL STATEMENT OF OFFICER
Article XVI, Section 1 of the Texas Constitution
Statement
I, Sam Gorgone, do solemnly swear (or affirm) that I have not directly or indirectly paid,
offered, promised to pay, contributed, or promised to contribute any money or thing of value,
or promised any public office or employment for the giving or withholding of a vote at the
election at which I was elected or as a reward to secure my appointment or confirmation,
whichever the case may be, so help me God.
Title of position to which elected or appointed: Regular Member
Execution
Under penalties of perjury, I declare that I have read the going statement and
that the facts stated therein are true.
1011.4)3
Date Signature of Officer
It is required that all elected or appointed state and local officers to take the official oath of office found
in section 1(a) and to subscribe to the anti-bribery statement found in section 1(b) before entering upon
the duties of their offices.
THE < ITT OF
COPPELL OATH OF OFFICE
Article XVI, Section 1 of the Texas Constitution
In the name and by the authority of The State of Texas
I, Sam Gorgone, do solemnly swear (or affirm), that I will faithfully execute the
duties of the office of the ANIMAL SERVICES ADVISORY AND APPEALS BOARD of
the State of Texas, and will to the best of my ability pres rve, protect, and defend
the Constitution and laws of the United States this S te, so help me God.
Signature of Office
Certification of Person Authorized to Administer Oath
State of Texas
County of Dallas
Sworn to and subscribed before me on this 511 day of December 2023.
(Affix Notary Seal, only if oath
administered by a notary.)
Signature of tary Public or
Signature of ther Person Authorized to
Agin":,, ASHLEY OWENS g
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Ashley Owens
Printed or Typed Name
Pursuant to Article XVI, Section 1 of the Texas Constitution, the Oath of Office may not be taken until a
Statement of Officer has been subscribed to and as required, filed.
THE CITY OF
COPPELL PUBLIC ACCESS OPTION FORM
Texas Government Code Section 552.024
The Public Information Act allows employees, public officials and former
employees and officials to elect whether to keep certain information about them
confidential. Unless you choose to keep it confidential, the following information
about you may be subject to public release if requested under the Texas Public
Information Act. Therefore, please indicate whether you wish to allow public
release of the following information.
Sam Gorgone
Printed Name
Do you Give Permission for Public Access to: NO YES
Please indicate by placing an "X" in appropriate box.
Home Address X
Home Phone Number
Cell Phone Number x
Email Address x
Social Security Number
Information that reveals whether you have family members.
Emergenc Cont.ct Information
4 a3
Signature Date
This form should be completed and signed by the employee no later than the 14th day after the date
the employee begins employment, the public official is elected or appointed, or a former employee
or official ends employment or service.