HomeMy WebLinkAboutStarnes Form CISLOCAL 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
in accordance with Chapter 176, Local Government Code.
Date Received
J Name of Local Government Officer
Charles N. Starnes
J Office Held
Councilmember District 1
J Name of person described by Sections 176.002(a) and 176.003(a), Local Government Code
Wayland Baptist University
LI D ription of the nature and e tent 1 employment or ther business relationship with person named in item 3
es i w-- 2
24)/ 44..
24 )/t r w i1 `y
J List gifts accepted by the local government officer and any family member, excluding gifts described by Section
176.003(a -1), if aggregate value of the gifts accepted from person named in item 3 exceed $250 during the 12 -month
period described by Section 176.003(a)(2)(B)
Date Gift Accepted Description of Gift
Date Gift Accepted Description of Gift
Date Gift Accepted Description of Gift
(attach additional forms as necessary)
II AFFIDAVIT
I swear under penalty of perjury that the above statement is true and correct. I acknowledge
that the disclosure applies to a family member (as defined by Section 176.001(2), Local
Government Code) of this loc. ernment officer I also acknowledge that this statement
.ii."' �rrLl aw Ht. ms escrib Section 003(a), Local Government Code.
k,. 4 0,100 covers the 12 -month period
STATE OF rfyS
try rnit,;i xf.m,, ttre 1a
trttcaera m tnt Signat re o Local Government Officer
AFFIX NOTARY STAMP SEAL ABOVE
Charles N. Starnes 12th
by the this the day
Sworn to and subscribed before me, said
of A ril 20 11 to certify which, witness my hand and seal of office.
Notary Public
Belinda Hinojosa
Si. ature of offi. j:dministering oath Printed name of officer administering oath Title of officer administering oath
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