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2. Name of vendor who has a business relationship with local government entity:*
4. Check this box if you are filing an update to a previously filed questionnaire:

   1. I am filing an update

   The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.
6. Name of local government officer about whom the information is being disclosed:*
8. Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership interest of one percent or more:*
10. Is the local government officer or a family member of the officer receiving or likely to receive taxable income, other than investment income, from the vendor?*

    1. Yes
    2. No
12. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer or a family member of the officer and the taxable income is not received from the local governmental entity.*

    1. Yes
    2. No
14. Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1):

    1. Vendor has given the local government officer or family member of the officer one or more gifts
16. Name of vendor doing business with the governmental entity:*
18. Date*
    Date
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20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit

* indicates a required field