CITY OF KEMAH DISCLOSURE FORM ‘OR CERTAIN ELECTED AND APPOINTED OFFICIALS In accordance with City of Kemah Ordinance No, 1101, adopted and approved by City Council on the second reading on October 16, 2013, and declared candidates for elective office, certain employees, and ‘members of specific City boards and committees must complete a disclosure statement showing all Property interests, stock ownership, and contributions. All information should be printed legibly in blue or black ink or typed. Each page (including additional pages if needed) shall include the official's name, date and page number. All information shall be identified as answering questions °a", "b” or “c’. Upon completion, this form is to be signed before a Notary Public. FOR EMPLOYEES OR COMMITTEE MEMBERS, AS DESCRIBED IN ORDINANCE NO. 1101: This information is due within ten (10) business days of receipt of this form and within ten (10) business days of the acquisition of any additional property interests as described above. Failure to comply with this requirement constitutes cause for removal from a committee or board appointment, or disciplinary action, of covered employees. To determine who is a board or committee member, or an employee who must complete this form, refer to Ordinance No. 1101. OFFICIAL'S NAME: MAMA TERESA VA2ZQUEZ-EVANS orrice HELD: CITY Counc. Posimoen 4, - pate, Dery 15,2022 PERMANENT RESIDENCE ADDRESS (Street Address and Apartment Number, if applicable. If none, describe location of residence (do not include PO Box or Rural Rt.) TOTAL NUMBER OF PAGES OF DISCLOSURE INFORMATION FORM: — Page 1DISCLOURE INFORMATION FORM Printed Name of City Officiat, MADIA TERESA VAZQNEZ-Everhse 9/15/27 A. Listall property owned or held in trust within the City limits and extraterritorial jurisdiction of the City. include legal description, location {address}, size (general dimensions) and current use. This includes Property that you own outright, under a mortgage, is leased, held in trust, or properties that are owned, leased, or held in trust by your spouse or dependent children, Attach additional pages if needed. if none, please state “none” Page 2DISCLOURE INFORMATION FORM Printed Name of chy offciat. MARIA TERESA VAZQNEZ-EVARS, 7/15/22 8. List the dollar amount and identify by name and address the source of all fees, salaries, or gifts of value exceeding twenty-five dollars ($25.00) received from companies or individuals under contract with the City during the twelve-month period prior to filing for public office or appointment. Attach additional pages if needed. If none, please state “none”. List the dollar amount and identify by name and address the source of all fees, salaries, or gifts of value exceeding twenty-five dollars ($25.00) received from companies or individuals under contract with the City during the twelve-month period Prior to filing for public office or appointment. Attach additional pages if needed. If none, please state “none”, NONE Page 3DISCLOURE INFORMATION FORM Printed Name of City Official: MARINA TERESA VAZQNEZ-EVANS.. 2/14 122 C._ List ownership of any interest in or membership or stock in companies or business entities under contract with the City if your ownership interest exceeds one (1) percent of the total ownership of the entity. None FIDAVIT | TERESA EVANS understand the requirements listed in Ordinance No. 1101, “Disclosure” and | have completed this form in accordance with these provisions. | swear that the disclosure information listed above or as attached on separate pages is true and correct. Signature of Official Sworn to and subscribed before me this \D_dayof Doky 20.22 (seal) hands 9 finistering Oath Chandra. Jobb , City Seoretary Name and Title of Officer Administering Oath Page 4CITY OF KEMAH DISCLOSURE FORM, FOR CERTAIN ELECTED AND APPOINTED OFFICIALS In accordance with City of Kemah Ordinance No. 1101, adopted and approved City Council on second reading on October 16, 2013, and declared candidates for elective office, certain employees, and members of specific City boards and committees must complete a disclosure statement showing all property interests, stock ownership, and contributions. All information should be printed legibly in blue or black ink or typed. Each page (including additional pages if needed) shall include the official's name, date and page number. All information shall be identified as answering questions “a”, “b” or “c”. Upon ‘completion, this form is to be signed before a Notary Public. FOR EMPLOYEES OR COMMITTEE MEMBERS, AS DESCRIBED IN ORDINANCE NO. 1101: This information is due within ten (10) business days of receipt of this form and within ten (10) business days of the acquisition of any additional property interests as described above. Failure to comply with this requirement constitutes cause for removal from a committee or board appointment, or disciplinary action of covered employees. To determine who is a board or committee member, or an employee who ‘must complete this form, refer to Ordinance No. 1101. OFFICIAL’S NAME: j 2 LC orrcenew COL werC Pos oN Q 7 vate 2/12 /Q PERMANENT RESIDENCE ADDRESS (Street Address and Apartment Number, if applicable. if none, ral Rt.) A TOTAL NUMBER OF PAGES OF DISCLOSURE INFORMATION FORM: Page 1DISCLOURE INFORMATION FORM. Printed Name of City Official: Yobaer? Hole ef Date: LL 3/2 A. List all property owned or held in trust within the City limits and extraterritorial jurisdiction of the City. Include legal description, location (address), size (general dimensions) and current use. This includes property that you own outright, under a mortgage, is leased, held in trust, or properties that are owned, leased, or held in trust by your spouse or dependent children, Attach additional ages if needed. If none, please state “none”. Page 2DISCLOURE INFORMATION FORM Printed Name of City Official 8. List the dollar amount and identify by name and address the source of all fees, salaries, or gifts of value exceeding twenty-five dollars ($25.00) received from companies or individuals under contract with the City during the twelve-month period prior to filing for public office or appointment. Attach additional pages if needed. If none, please state “none” List the dollar amount and identify by name and address the source of all fees, salaries, or gifts of value exceeding twenty-five dollars ($25.00) received from companies or individuals under contract with the City during the twelve-month Period prior to filing for public office or appointment. Attach additional pages if needed. If none, please state “none”. NOVE Page 3DISCLOURE INFORMATION FORM r Dp Printed Name of city offal: Shao Li Date: C._ List ownership of any interest in or membership or stock in companies or business entities under contract with the City if your ownership interest exceeds one (1) percent of the total ownership of the entity. UOVve® AFEIDAVIT 1 eee eee the requirements listed in Ordinance Ni 1101, “Disclosure” and | have completed this form jr’accordance with these provisions. | swe fisclosure information listed above or as attachéd on separate pages is true and correct. th Swor to and subscribed before me this {3° dayot July 20.2 Signature of officer ate ‘Oath Chandra Tabb Acct. tll Tame and Tite of Ofer Aaristering Oath PE Page 4CITY OF KEMAH DISCLOSURE FORM FOR CERTAIN ELECTED AND APPOINTED OFFICIALS In accordance with City of Kemah Ordinance No. 1101, adopted and approved by City Council on the second reading on October 16, 2013, and declared candidates for elective office, certain employees, and members of specific City boards and committees must complete a disclosure statement showing all Property interests, stock ownership, and contributions. All information should be printed legibly in blue or black ink or typed. Each page (including additional pages if needed) shall include the official's name, date and page number. All information shall be identified as answering questions “a’’, “b” or “c’. Upon completion, this form is to be signed before a Notary Public. FOR EMPLOYEES OR COMMITTEE MEMBERS, AS DESCRIBED IN ORDINANCE NO. 1101: This information is due within ten (10) business days of receipt of this form and within ten (10) business days of the acquisition of any additional property interests as described above. Failure to comply with this requirement constitutes cause for removal from @ committee or board appointment, or disciplinary action of covered employees. To determine who is a board or committee member, or an employee who must complete this form, refer to Ordinance No. 1101. OFFICIAL’S NAME \ com Beowous orncevei, Oty Coane! orton 2. oate. 2]g a2 PERMANENT RESIDENCE ADDRESS (Street Address and Apartment Number, if applicable. If none, describe location of residence (dp not include PO Box or Rural Rt.) ‘TOTAL NUMBER OF PAGES OF DISCLOSURE INFORMATION FORM: Page 1CITY OF KEMAH DISCLOSURE FORM FOR CERTAIN ELECTED AND APPOINTED OFFICIALS In accordance with City of Kemah Ordinance No. 1101, adopted and approved City Council on second. reading on October 16, 2013, and declared candidates for elective office, certain employees, and members of specific City boards and committees must complete a disclosure statement showing all Property interests, stock ownership, and contributions. All information should be printed legibly in blue or black ink or typed. Each page (including additional pages if needed) shall include the official's name, date and page number. All information shall be identified as answering questions “a”, "b” or “ce”. Upon completion, this form is to be signed before a Notary Public. FOR EMPLOYEES OR COMMITTEE MEMBERS, AS DESCRIBED IN ORDINANCE NO. 1101: This information is due within ten (10) business days of receipt of this form and within ten (10) business days of the acquisition of any additional property interests as described above. Failure to comply with this requirement constitutes cause for removal from a committee or board appointment, or disciplinary action of covered employees. To determine who is a board or committee member, or an employee who must complete this form, refer to Ordinance No. 1101. oricarsname_Daccan 8 Coadus OFFICE HELD: Gay dural Position 2 - one. 2172/2022 PERMANENT RESIDENCE ADDRESS (Street Address and Apartment Number, if applicable. if none, describe location of residence (do not include PO Box or Rural Rt.) ‘TOTAL NUMBER OF PAGES OF DISCLOSURE INFORMATION FORM: _ Page 1p\s10URE Nronburiow Fon mint name ofc one Warten Beads vate, 2fi7/ez. ‘A. List all property owned or held in trust within the City limits and extraterritorial jurisdiction of the City. Include legal description, location (address), size (general dimensions) and current use. This includes property that you own outright, under a mortgage, is leased, held in trust, or properties that are owned, leased, or held in trust by your spouse or dependent children, Attach additional ages if needed. If none, please state “none”, Page 2DISCLOURE INFORMATION FORM. Printed Name of City Official Darren Groodlys vate:_2f 17/22. 8. List the dollar amount and identify by name and address the source of all fees, salaries, or gifts of value exceeding twenty-five dollars ($25.00) received from companies or individuals under contract with the City during the twelve-month period prior to filing for public office or appointment. Attach additional pages if needed. If none, please state “none” List the dollar amount and identify by name and address the source of all fees, salaries, or gifts of value exceeding twenty-five dollars ($25.00) received from companies or individuals under contract with the City during the twelve-month period prior to filing for public office or appointment. Attach additional pages if needed. If none, please state “none”. Page 3DISCLOURE INFORMATION FORM mrinted ame ofc ofreat, WAY CON BFoadus ore 2/7/22. C. List ownership of any interest in or membership or stock in companies or business entities under contract with the City if your ownership interest exceeds one (1) percent of the total ownership of the entity 3 AFFIDAVIT Daccan fades understand the requirements listed @ Ordinance No, 1101, “Disclosure” and | have completed this form in accordance with these provis(ons. Nswedk that the disclosure information listed above or as attached on separate pages is true and c \\ Signature oPOfficial 2092. Sworn to and subscribed before me this}. day of [= Signature of Officer Administering 0: Name and Bey ‘Administering Oath Page 4CITY OF KEMAH DISCLOSURE FORM FOR CERTAIN ELECTED AND APPOINTED OFFICIALS In accordance with City of Kemah Ordinance No. 1101, adopted and approved by City Council on the second reading on October 16, 2013, and declared candidates for elective office, certain employees, and members of specific City boards and committees must complete a disclosure statement showing all property interests, stock ownership, and contributions. All information should be printed legibly in blue or black ink or typed. Each page (including additional pages if needed) shall include the official's name, date and page number. All information shall be identified as answering questions “a”, “b” or “c". Upon completion, this form isto be signed before a Notary Public. FOR EMPLOYEES OR COMMITTEE MEMBERS, AS DESCRIBED IN ORDINANCE NO. 1101: This information is due within ten (10) business days of receipt of this form and within ten (10) business days of the acquisition of any additional property interests as described above. Failure to comply with this requirement constitutes cause for removal from a committee or board appointment, or disciplinary action of covered employees. To determine who is a board or committee member, or an employee who must complete this form, refer to Ordinance No. 1101 orticarsname, Aus Ae isa cer orncene:_CVy Couaci/ (os. 3 vate: 2/1/22 PERMANENT RESIDENCE ADDRESS (Street Address and Apartment Number, if applicable. If none, describe location of residence (do not include PO Box or Rural Bi ‘TOTAL NUMBER OF PAGES OF DISCLOSURE INFORMATION FORI Page 1DISCLOURE INFORMATION FORM. Printed Name of cy offciat_ a Doug WA v'sinpen vate_2/2/22- A. Listall property owned or held in trust within the City limits and extraterritorial jurisdiction of the City. Include legal description, location (address), size (general dimensions) and current use. This includes property that you own outright, under a mortgage, is leased, held in trust, or properties that are ‘owned, leased, or held in trust by your spouse or dependent children. Attach additional pages if, needed. if none, please state “none”. owe Page 2Printed Name of City Official:_ dows ude 's (age Date B DISCLOURE INFORMATION FORM Btf2z List the dollar amount and identify by name and address the source of all fees, salaries, or gifts of value exceeding twenty-five dollars ($25.00) received from companies or individuals under contract with the City during the twelve-month period prior to filing for public office or appointment. Attach additional pages if needed. if none, please state “none”. List the dollar amount and identify by name and address the source of all fees, salaries, or gifts of value exceeding twenty-five dollars ($25.00) received from companies or individuals under contract with the City during the twelve-month period prior to filing for public office or appointment. Attach additional pages if needed. If none, please state “none”, one Page 3DISCLOURE INFORMATION FORM Printed Name of City Official:_A Dus, Mew'sia ter vate_p// 22 C. Uist ownership of any interest in or membership or stock in companies or business entities under contract with the City if your ownership interest exceeds one (1) percent of the total ownership of the entity AFFIDAVIT 1 eds Hes fa pzinderstand the requirements listed in Ordinance No. 1101, “Disclosure” and have confpleted this fdrm in accordance with these provisions. | swear that the disclosure information listed above or as attached on separate pages is true and correct. — SenaturkeF eal ‘Sworn to and subscribed before me this_/ dayof #yzt Pa. Jeonseete Date: Yofas C. List ownership of any interest in or membership or stock in companies or business entities under contract with the City if your ownership interest exceeds one (1) percent of the total ownership of the entity. None. AFFIDAVIT |, cote A~dou>pe, understand the requirements listed in Ordinance No. 1101, “Disclosure” and | have completed this form in accordance with these provisions. | swear that the disclosure inform listed above or as attached on separate pages is true and correct. Signature of Official sworn to and subscribed before me this! _dayof SUN _,20°2.\ gal) JESSICA MCCLAIN Signgture of Officer Administering Oath Notary Pu tat oon . . Comm Expireed309-2028 sco. MeClainy - Notor4 Notary 1D 13295174-1 Name and Title of Officer Administering Oath Page 4CITY OF KEMAH DISCLOSURE FORM FOR CERTAIN ELECTED AND APPOINTED OFFICIALS In accordance with City of Kemah Ordinance No. 1101, adopted and approved by City Council on the second reading on October 16, 2013, and declared candidates for elective office, certain employees, and members of specific City boards and committees must complete a disclosure statement showing all property interests, stock ownership, and contributions. All information should be printed legibly in blue or black ink or typed. Each page (including additional pages if needed) shall include the official's name, date and page number. All information shall be identified as answering questions “a”, “b” or “c’. Upon completion, this form is to be signed before a Notary Public. FOR EMPLOYEES OR COMMITTEE MEMBERS, AS DESCRIBED IN ORDINANCE NO. 1101: This information is due within ten (10) business days of receipt of this form and within ten (10) business days of the acquisition of any additional property interests as described above. Failure to comply with this requirement constitutes cause for removal from a committee or board appointment, or disciplinary action of covered employees. To determine who is a board or committee member, or an employee who must complete this form, refer to Ordinance No. 1101. orricavsname: KK QV¥V\_ ¥edlS orice we: KCC. “Position 2. pate:_ \\\3 19.3. PERMANENT RESIDENCE ADDRESS (Street Address and Apartment Number, if applicable. If none, ‘TOTAL NUMBER OF PAGES OF DISCLOSURE INFORMATION FORM: Page 1DISCLOURE INFORMATION FORM Printed Name of City Official: K ave Sercols vate: 4] (3]99. A List all property owned or held in trust within the City limits and extraterritorial jurisdiction of the City. Include legal description, location (address), size (general dimensions) and current use. This includes property that you own outright, under a mortgage, is leased, held in trust, or properties that are owned, leased, or held in trust by your spouse or dependent children. Attach additional pages if needed. If none, please state “none”. Page 2DISCLOURE INFORMATION FORM Karri Seeds Date: 413/22 B. List the dollar amount and identify by name and address the source of all fees, salaries, or gifts of value exceeding twenty-five dollars ($25.00) received from companies or individuals under contract with the City during the twelve-month period prior to filing for public office or appointment. Attach additional pages if needed. If none, please state “none”. List the dollar amount and identify by name and address the source of all fees, salaries, or gifts of value exceeding twenty-five dollars ($25.00) received from companies or individuals under contract with the City during the twelve-month period prior to filing for public office or appointment. Attach additional pages if needed. if none, please state “none”. Printed Name of City Offi Page 3DISCLOURE INFORMATION FORM Printed Name of City officia: AG Vi Seeds pate:_')|\ C. List ownership of any interest in or membership or stock in companies or business entities under contract with the City if your ownership interest exceeds one (1) percent of the total ownership of the entity. None. AFFIDAVIT 1 Kon, Seca understand the requirements listed in Ordinance No. 1101, “Disclosure” and | have completed this form in accordance with these provisions. | swear that the disclosure information listed above or as attached on separate pages is true and correct. Signature Sf Official ‘Sworn to and subscribed before me this QO, dayofSpei\ 258. (seal) sliRature of Officer Administering Oath cu. allace aed Name and Title of Officer Administering Oath lotary Public, State of Texas ‘Come. Expites 11-02-2022 Notary ID 6368309 Page 4CITY OF KEMAH DISCLOSURE FORM FOR CERTAIN ELECTED AND APPOINTED OFFICIALS In accordance with City of Kemah Ordinance No. 1101, adopted and approved City Council on second reading on October 16, 2013, and declared candidates for elective office, certain employees, and members of specific City boards and committees must complete a disclosure statement showing all Property interests, stock ownership, and contributions. All information should be printed legibly in blue or black ink or typed. Each page (including additional pages if needed) shall include the official's name, date and page number. All information shall be identified as answering questions “a", “b" or “c”. Upon completion, this form is to be signed before a Notary Public. FOR EMPLOYEES OR COMMITTEE MEMBERS, AS DESCRIBED IN ORDINANCE NO. 1101: This information is due within ten (10) business days of receipt of this form and within ten (10) business days of the acquisition of any additional property interests as described above. Failure to comply with this requirement constitutes cause for removal from a committee or board appointment, or disciplinary action of covered employees. To determine who is a board or committee member, or an employee who must complete this form, refer to Ordinance No. 1101. orncwswame,__KELLIM AWS oN, orrice Hew KCDC PosiTiwN Z oare__T]I4[ 9094 PERMANENT RESIDENCE ADDRESS (Street Address and Apartment Number, if applicable, If none, cr Rural Rt.) TOTAL NUMBER OF PAGES OF DISCLOSURE INFORMATION FORM: Page 1DISCLOURE INFORMATION FORM, Printed Name otctyorrcat KELLEY DAWSON owe, ty [2.024 A. List all property owned or held in trust within the City limits and extraterritorial jurisdiction of the City. Include legal description, location (address), size (general dimensions) and current use. This includes property that you own outright, under a mortgage, Is leased, held in trust, or properties that are owned, leased, or held in trust by your spouse or dependent children. Attach additional eesti ABST. AE, M. MuULOoon) SUA vey LoS F+¢ Hite Homes SUBD AG4L0 sg. Live ApER 303% acy land Page 2DISCLOURE INFORMATION FORM printed Name of cry offical: KELLEY DAwSoh) oate_ 7/14 [dea B. List the dollar amount and identify by name and address the source of all fees, salaries, or gifts of value exceeding twenty-five dollars ($25.00) received from companies or individuals under contract with the City during the twelve-month period prior to filing for public office or appointment. Attach additional pages if needed. If none, please state “none” List the dollar amount and identify by name and address the source of all fees, salaries, or gifts of value exceeding twenty-five dollars ($25.00) received from companies or individuals under contract with the City during the twelve-month Period prior to filing for public office or appointment. Attach additional pages if needed. If none, please state “none”. NoWe Page 3DISCLOURE INFORMATION FORM. Printed Name of cy offca KELLEY Ofw Sad) oae_ 9 }I4] 9001 . List ownership of any interest in or membership or stock in companies or business entities under contract with the City if your ownership interest exceeds one (1) percent of the total ownership of the entity. Nowe ‘AFFIDAVIT LYELL DA otJunderstand the requirements listed in Ordinance No. 1101, “Disclosure” and | have completed this form in accordance with these provisions. | swear that the disclosure information listed above or as attached on separate pages is true and correct. Signattire of Offi Sworn to and subscribed before me this ly dayof dul 2A (seal) ature of Officer Administering Oath MW Page 4CITY OF KEMAH DISCLOSURE FORM, FOR CERTAIN ELECTED AND APPOINTED OFFICIALS Im accordance with City of Kemah Ordinance No. 1101, adopted and approved City Council on second reading on October 16, 2013, and declared candidates for elective office, certain employees, and members of specific City boards and committees must complete a disclosure statement showing all property interests, stock ownership, and contributions. All information should be printed legibly in blue or black ink or typed. Each page (including additional pages if needed) shall include the official's name, date and page number. All information shall be identified as answering questions “a”, “b” or “c”. Upon completion, this form is to be signed before a Notary Public. FOR EMPLOYEES OR COMMITTEE MEMBERS, AS DESCRIBED IN ORDINANCE NO. 1101: This information Is due within ten (10) business days of receipt of this form and within ten (10) business days of the acquisition of any additional property interests as described above. Failure to comply with this requirement constitutes cause for removal from a committee or board appointment, or disciplinary action of covered employees. To determine who is a board or committee member, or an employee who ‘must complete this form, refer to Ordinance No, 2101. orcas name, KELLEY OY\WSon) orrcenew: KCOC BOARD MEMBER POSITION Z ome_Hid}i@ PERMANENT RESIDENCE ADDRESS (Street Address and Apartment Number, if applicable. If none, describe location of residence (do not include PO Box or Rural Rt. ‘TOTAL NUMBER OF PAGES OF DISCLOSURE INFORMATION FORM: Page 1DISCLOURE INFORMATION FORM. Printed Name of cty ofneia: IZELLEY DAlWSoN) vate 7 //3// ‘A, List all property owned or held in trust within the City limits and extraterritorial jurisdiction of the City. Include legal description, location (address), size (general dimensions) and current use. This includes property that you own outright, under a mortgage, is leased, held in trust, or properties that are owned, leased, or held in trust by your spouse or dependent children. Attach additional pages if needed. if none, please state “none”, Page 2DISCLOURE INFORMATION FORM. VE LEY DAwseN) vate 9] {3] Je B. List the dollar amount and identify by name and address the source of all fees, salaries, or gifts of value exceeding twenty-five dollars ($25.00) received from companies or individuals under contract with the City during the twelve-month period prior to filing for public office or appointment. Attach additional pages ifneeded. If none, please state “none” List the dollar amount and identify by name and address the source of all fees, salaries, or gifts of value exceeding twenty-five dollars ($25.00) received from companies or individuals under contract with the City during the twelve-month Period prior to filing for public office or appointment. Attach additional pages if needed. if none, please state “none”. Printed Name of City Offic NONE NONE Page 3DISCLOURE INFORMATION FORM Printed Name of cy ofa KELLEY _DeWSON) ate PUI3|IL C._Uist ownership of any interest in or membership or stock in companies or business entities under contract with the City if your ownership interest exceeds one (1) percent of the total ownership of the entity. NONE AFFIDAVIT | KcLus/ PASO) _ understand the requirements sted in Ordinance No, 1101, “Disclosure” and! have completed this form in accordance with these provisions. | swear that the disclosure information listed above or as attached on separate pages is true and correct. ol [epboucer ighature of Sfficial ‘Sworn to and subscribed before me this_day of | 20___. (seal) Signature of Officer Administering Oath Name and Ttie of Officer Administering Oath Page 4CITY OF KEMAH DISCLOSURE FORM FOR CERTAIN ELECTED AND APPOINTED OFFICIALS In accordance with City of Kemah Ordinance No. 1101, adopted and approved City Council on second reading on October 16, 2013, and declared candidates for elective office, certain employees, and members of specific City boards and committees must complete a disclosure statement showing all property interests, stock ownership, and contributions. All information should be printed legibly in blue or black ink or typed. Each page (including additional pages if needed) shall include the official's name, date and page number. All Information shat! be identified as answering questions "a", "b” or "c’. Upon completion, this form is to be signed before a Notary Public, FOR EMPLOYEES OR COMMITTEE MEMBERS, AS DESCRIBED IN ORDINANCE NO. 1101: This information {is due within ten (10) business days of receipt of this form and within ten (10) business days of the acquisition of any additional property Interests as described above. Failure to comply with this rout constitutes cause for removal from a committee or board appointment, or disciplinary action of covered employees, To determine who is a board or committee member, or an employee who ‘must complete this form, refer to Ordinance No, 1101, orntcavsname Kis “Reisee orncene PODC Pps.) aD PERMANENT RESIDENCE ADDRESS (Street Address and Apartment Number, if applicable. If none, describe location of residence (do not include PO Box or Rural Rt.) TOTAL NUMBER OF PAGES OF IscLosuRE WFoRMaTION FoRM;__4| Dat Page 1DISCLOURE INFORMATION FORM Printed Name of City official:__ AWS i __ date} 3-21 ‘A. Ust all property owned or held in trust within the City limits and extraterritorial jurisdiction of the City. Include legal description, location (address), size (general dimensions) and current use. This includes property that you own outright, under a mortgage, is leased, held in trust, or properties that are owned, leased, or held in trust by your spouse or dependent children, Attach additional ages ifneeded. If none, please state “none”. Page 2DISCLOURE INFORMATION FORM » Wash Keiser pate:_|- ¥3+2I 8. List the dollar amount and identify by name and address the source of all fees, salaries, or gifts of value exceeding twenty-five dollars ($25.00) received from companies or individuals under contract with the City during the twelve-month period prior to filing for public office or appointment. Attach additional pages if needed. If none, please state “none” List the dollar amount and identify by name and address the source of all fees, salaries, or gifts of value exceeding twenty-five dollars ($25.00) received from companies or individuals under contract with the City during the twelve-month period prior to filing for public office or appointment. Attach additional pages if needed, if none, please state “none”. None Printed Name of City Offic Page 3DISCLOURE INFORMATION FORM r Knish: Reiser pate__\+ (4 -2| C. List ownership of any interest in or membership or stock in companies or business entities under contract with the City if your ownership interest exceeds one (1) percent of the total ownership of tthe entity Printed Name of City Offic née FIDAVIT 4 understand the requirements listed in Ordinance No. 1401, “Disclosure” and | have completed this form in accordance with these provisions. | swear that the disclosure Information listed above or as attached on separate pages is true and correct. Signature of Official +h ‘Sworn to and subscribed before me this / 9" day of January 202). Signature of dea lle — Oath ‘Name and Tite of Office? Administering Oath 7 Page 4CITY OF KEMAH DISCLOSURE FORM FOR CERTAIN ELECTED AND APPOINTED OFFICIALS 'n accordance with City of Kemah Ordinance No. 1101, adopted and approved City Council on second reading on October 16, 2013, and declared candidates for elective office, certain employees, and members of specific City boards and committees must complete a disclosure statement showing all property interests, stock ownership, and contributions. All information should be printed legibly in blue or black ink or typed. Each page (including additional pages if needed) shall include the official's name, date and page number. All information shall be identified as answering questions “a”, “b” or “c”. Upon completion, this form is to be signed before a Notary Public. FOR EMPLOYEES OR COMMITTEE MEMBERS, AS DESCRIBED IN ORDINANCE NO. 1101: This information is due within ten (10) business days of receipt of this form and within ten (10) business days of the acquisition of any additional property interests as described above. Failure to comply with thi requirement constitutes cause for removal from a committee or board appointment, or disciplinary action of covered employees. To determine who is a board or committee member, or an employee who must complete this form, refer to Ordinance No. 1101. orricavsname: _JWATT wed DM. WisGins sr. KeDe Direcror __ 46 DATE: 7. 28, fey PERMANENT RESIDENCE ADDRESS (Street Address and Apartment Number, if applicable. If none, ———E ‘TOTAL NUMBER OF PAGES OF DISCLOSURE INFORMATION FORM: Bi OFFICE HELI Page 1DISCLOURE INFORMATION FORM. CGINS Date:_] teloy A. List all property owned or held in trust within the Cit City. Include legal description, location (address), includes property that you own outright, under a that are owned, leased, or held in trust by your s} Pages if needed. Ifnone, please state “none’, Printed Name of City Offici ity limits and extraterritorial jurisdiction of the size (general dimensions) and current use. This mortgage, is leased, held in trust, or properties pouse or dependent children. Attach additional SEE LIST OF Galveston county Pearep c/ Page 2DISCLOURE INFORMATION FORM. Printed Name of city official:__ W/-G-/ JC Dat SEIN 7G, lz, B. Uist the dollar amount and identify by name and address the Source of all fees, salaries, or gifts of value exceeding twenty-five dollars ($25.00) received from Companies or individuals under contract with the City during the twelve-month period prior to filing for public office or appointment. Attach additional pages if needed. ifnone, please state “none” List the dolar amount and identify by name and address the source of all fees, salaries, or gifts of value exceeding twenty-five dollars ($25.00) ‘eceived from companies or individuals under contract with the Gity during the twelve-month Period prior to fling for public office or appointment. Attach additions! Pages if needed. If none, please state "none", Noor Page 3DISCLOURE INFORMATION FORM Printed Name of city offcia:_ WGN AREIDAVIT 1 understand the requirements listed in Ordinance No, 1101, “Disclosure” and | have completed this form in accord; that the disclosure information lance with these provisions. | swear: listed above or as attached on separate pages is true and correct Signature of Official Ts i 20d\. acene Mn Signature of Officer Administering Oath Dale L. Hamaker Noturg Pablee Name and Title of Officer Administeri Oath Sworn to and subscribed before me this_\4" “Yay of Date Hamaker My Commason Expos IO Ne askance Page 4CITY OF KEMAH DISCLOSURE FORM FOR CERTAIN ELECTED AND APPOINTED OFFICIALS In accordance with City of Kemah Ordinance No. 1101, adopted and approved City Council on second reading on October 16, 2013, and declared candidates for elective office, certain employees, and members of specific City boards and committees must complete a disclosure statement showing all property interests, stock ownership, and contributions. All information should be printed legibly in blue or black ink or typed. Each page (including additional pages if needed) shall include the official's name, date and page number. All information shall be identified as answering questions “a”, “b” or “c". Upon completion, this form is to be signed before a Notary Public and provided to the City Secretary. FOR EMPLOYEES OR COMMITTEE MEMBERS, AS DESCRIBED IN ORDINANCE NO. 1101: This information Is due within ten (10) business days of receipt of this form and within ten (10) business days of the acquisition of any additional property interests as described above, Failure to comply with this requirement constitutes cause for removal from a committee or board appointment, or disciplinary action of covered employees. To determine who is a board or committee member, or an employee who ‘must complete this form, refer to Ordinance No. 1101. OFFICIAL’S NAME: Jaca a ornice wen: KC OC osthon “7 oar, [15 Jad PERMANENT RESIDENCE ADDRESS (Street Address and Apartment Number, if applicable. if none, describe location of residence (do not include PO Box or Rural Rt TOTAL NUMBER OF PAGES OF DISCLOSURE INFORMATION FORM: Page 1DISCLOURE INFORMATION FORM Primed Name of cryorreat ACO Bignec pate: S/S (as ‘A. List all property owned or held in trust within the City limits and extraterritorial jurisdiction of the City. Include legal description, location (address), size (general dimensions) and current use. This includes property that you own outright, under a mortgage, is leased, held in trust, or properties ‘that are owned, leased, or held in trust by your spouse or dependent children. Attach additional pages if needed. if none, please state “none”. AlaniO Ge Page 2DISCLOURE INFORMATION FORM rnd name otciy orca: TACO Roiggwc vate: 3/IS/3 B. st the dollar amount and identify by name and address the source of all fees, salaries, or gifts of value exceeding twenty-five dollars ($25.00) received from companies or individuals under contract with the City during the twelve-month period prior to filing for public office or appointment. Attach additional pages if needed. If none, please state “none” List the dollar amount and identify by name and address the source of all fees, salaries, or gifts of value exceeding twenty-five dollars ($25.00) received from companies or individuals under contract with the City during the twelve-month period prior to filing for public office or appointment. Attach additional pages if needed. If none, please state “none”. Awe. Rr Page 3DISCLOURE INFORMATION FORM Printed Name ofcty ofrent, Jercohy Bivagy 0 vate: 3/(s/ad C. List ownership of any interest in or membership or stock in companies or business entities under contract with the City if your ownership interest exceeds one (1) percent of the total ownership of, the entity. Nowe. Br AFFIDAVIT | Dacobh Re SiGg9f understand the requirements sted in Ordinance No, 101, “Disclosure” and have completed this form in accordance with these provisions. | swear that the disclosure information listed above or as attached on separate pages is true and correct. sworn to and subscribed before me this (St Nayor_ Marclh_203.%, Signature of Officer it ‘Oath Chonaia. Jobb. City Seervtary Name and Title of Officer Administering Oath Page 4ORDINANCE NO, 1101 AN ORDINANCE REQUIRING CERTAIN OFFICERS TO FILE A SWORN DISCLOSURE OF INTEREST(S) IN REAL PROPERTY IN THE CITY OR IN A CORPORATION OR BUSINESS ED CONTRACT WITH THE CITY; PROVIDING CONSEQUENCES INCLUDING FORFEITURE OF OFFICE FOR MALFEASANCE FOR VIOLATION OF SAME. BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF KEMAH, TEXAS THAT: The members of Council, the City Administrator, and the members of the Kemah Community Development Corporation shall within 30 days of election or appointment, complete and file with the City Seerewry a sworn disclosure statement, on a form generated by the City for that purpose, listing all interests in real property located within the city limits or the extraterritorial Jurisdiction of the City, whether owned outright or under @ mortgage or lease, or held in trust by another party or held by said officer's spouse or dependent children. This disclosure shall include the location of said real property (street address or legal description), its size and current use, Furthermore, this disclosure shall inelude his or her ownership of stock or membership interest in @ company or business entity under contract with the City or on an agenda for consideration for a contract with the City, when such ownership comprises more than one percent of the business entity's total stock or membership. This section shall become effective for the current members of council, the City Administrator, and the members of the Kemah Community Development Corporation within 30 days of final passage of this ordinance. Thereafter, all officers named herein shall file an amended statement within 310 days of the acquisition of any additional real Property interest as defined above or stock or interest in a corporation or business entity as defined above. This requirement to disclose shall apply to such officers during the term of any elected office, appointed office or employment (in the case of the City Administrator) of that officer. Any willful violation of this section or this ordinance shall constitute malfeasance in and shall be cause for removal for such malfeasance in office and any such elected or appointed official or employee guilty thereof shall forfeit the office or position and shall be subject to removal from office in a manner authorized by law PASSED AND APPROVED ON FIRST READING THIS THE 2ND DAY OF OCTOBER 2013. PASSED AND APPROVED ON SECOND READING THIS THE 16TH DAY OF OCTOBER 2013. AFTER SECOND READING, 4 ~ Ly ATTEST: frre, 2 MARISELA GARCIA, CITY SECRETARY