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Bankin§ for you.
RICHARD THORNBERRy
SENIOR VICE PRESIDENT
March 21, 2006
City of Plainview
Attn: Jack Keller
121 West 7th St
Plainview, TX 79072
Dear Mr. Keller,
Enclosed isa ~t~endor,s Conflicts Disclosure Statement" as required b
Govermnent C0de~ofthe State of Tex- .... _ y. Chapter I76 of the
records. - - u~. incase nave your records admimstrator file this in your
Richard Thomberry ~
RECEIVED
~A~ 24 2006
t PLAINV!E~q~ CiTY ~,~qANAGER
806-741-2384 FAX: 806-763-8269 richard~asbongne.com
1401 Avenue Q P.O. Box 1401 Lubbock, TX 79408-1401
I~Iemb er FDIC
CONFLICT OF INTEREST QUESTIONNAIRE FORM
For vendor or other person doing business with local governmental entity
OFFICE USE ONLY
This questionnaire is being flied in accordance with chapter 176 of the Local
Government Code by a person doing business with the governmental entity. Date Received
By law this questionnaire must be filed with the records administrator of the
local government not later than the 7th business day after the date the person
becomes aware of facts that require the statement to be filed. See Section
176.006, Local Government Code,
A person commits an offense if the person violates Section 176,006, Local
Government Code. An offense under this section is a Class C misdemeanor.
~ Name of person doing business with local governmental entity.
American State Bank, Lubbock, Taxes
~-~ boxlfyo arefili ga pd tetoapreviou re.
Check this u n n u a sly filed questionnsi
(The law requires that you file an updated completed questionnaire ~vith the appropriate filing authorit~ not later than
September t of the year for which an activity described in Section 176.006(a), Local Government Code, is pending and
not later than the 7th business day after the :date the originally filed.questionnaire becomes incomplete or inaccurate.)
3_J Describe each affiliation or business relationship with an employee or contractor of the local governmental entity who makes
recommendations 'lo a local government officer of the local governmental entity with respect to expenditure of money,
In American State Bank's general course of day to da% business, the bank has
contacts with various individuals and businesses. Some may be affiliated or
directly involved with the public depository. American State Bank's bid
submission for this public depoaitory has not been influenced by any
affiliation or business interest relating to any checking accounts, time
accounts or other activities that the bank might have with any pertinent
public depository official or representative-
4_J Describe each affiliation or business relationship with a Demon who is a local g~vernment officer and who appoints or
employs a local government officer of the local governmental entity that is the subject of this questionnaire.
S'ee (3.) above.
CONFLICT OF INTEREST QUESTIONNAIRE
For vendor or other person doing business with local governmental entity
FORM ClQ
Page 2
Nam~ of local government officer with whom filer t~as affilitation or business relationship. (Complete this section only if the
answer to A, B, or C [s YES.)
This section, item 5 including subparts A, B, C & D, must be completed for each officer with whom the filer nas affiliation or
business relationship. Attach additiof]a{ pages to this Form ClQ as necessary.
A. Is the local government officer named in this section receiving or likely to receive taxable income from the flier of the
questionnaire?
E~Yes ~-] No
Is the filer of the ouestionnaire receiving or likely [o receive taxable income from or au the direction of the local govemment
officer named in th~s section AND the ~axable income is not from the local govemmental entity?
E~] Yes r---] No
c, is me fi~er of this questionnaire affiliated with a corporation or other business entity that the locei government officer serves
as an officer or director, or ho~ds an ownership of 10 percent or more?
~---] Yes ~ No
D. Descdbe each affiliation or business relationship.
See (3.) or~ page one.
~ Describe any other affiliation or business relationship that might cause a c°nffict of interest
See (3.) on page one.
American State Bank, Lubbock, Texas
Richa=~ Thor~berr¥, S=. ~iC,evePmmre~eg~