AISD : Inside AISD : Chapter 176 of the Texas Local Government Code
Chapter 176 of the Texas Local Government Code
Form CIS for Employees - Online Conflict of Interest Disclosure Form CIQ for Vendors - Conflict of Interest Questionairre Submitted CIS Forms (Employees) Submitted CIQ Forms (Vendors) 		 
Chapter 176 of the Texas Local Government Code
Form CIS - Conflict of Interest Disclosure

Local Government Officer Conflicts Disclosure Statement

Section 176.003 of the Local Government Code requires certain local government officers to file this form. A "local government officer" is defined as a member of a governing body of a local government entity or a director, superintendent, administrator, president, or other person designated as the executive officer of the local government entity. This form is required to be filed with the records administrator of the local governmental entity not later than 5 p.m. on the seventh business day after the date on which the officer becomes aware of the facts that require the filing of this statement.

A local government officer commits an offense if the officer knowingly violates Section 176.003, Local Government Code. An offense under this section is a Class C misdemeanor.

Please refer to chapter 176 of the Local Government Code for detailed information regarding the requirement to file this form.

INSTRUCTIONS FOR COMPLETING THIS FORM

The following numbers correspond to the numbered boxes on the other side.

  1. Name of Local Government Officer. Enter the name of local government officer filing this statement.
  2. Office Held. Enter the name of the office held by the local government officer filing this statement.
  3. Name of person described by Sections 176.002(a) and 176.003(a), Local Government Code. Enter the name of the person described by Section 176.002, Local Government Code with whom the officer has an employment or other business relationship as described by Section 176.003(a), Local Government Code.
  4. Description of the nature and extent of employment or business relationship with person named in item 3. Describe the nature and extent of the relationship of the employment or other business relationship with the person in item 3 as described by Section 176.003(a), Local Government Code.
  5. List gifts if aggregate value of the gifts received from person named in number 3 exceed $250. List gifts received during the 12-month period (described by Section 176.003(a)(2)(B), Local Government Code) by the local government officer or family member of the officer from the person named in number 3 that in the aggregate exceed $250 in value.

1. Name of Local Government Officer

2. Office Held

3. Name of person described by Sections 176.002(a) and 176.003(a), Local Government Code

4. Description of the nature and extent of employment or business relationship with person named in item 3

5. List gifts if aggregate value of the gifts received from person named in item 3 exceed $250

Date Gift Received
Description of Gift
Did Not Accept Gift

Date Gift Received
Description of Gift
Did Not Accept Gift

Date Gift Received
Description of Gift
Did Not Accept Gift

* Please enter the following number into the textbox below for verification:
     

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 a government officer. I also acknowledge that this statement covers the 12-month period described by Section 176.003(a)(2)(b), Local Government Code. (electronic signature)

* The verification code is required to ensure that this form is not used for internet spam.
Chapter 176 of the Texas Local Government Code