Harlingen CISD
031903

EMPLOYMENT REQUIREMENTS AND RESTRICTIONS:
CONFLICT OF INTEREST




DBD
(EXHIBIT)

 

 

 
See the following pages for forms to be used by employees for disclosing potential 
conflicts of interest:                                                             
 
 
Exhibit A:   Affidavit Disclosing Substantial Interest in a Business Entity or in  
             Real Property, as defined in Local Government Code 171.002 - 2 pages  
 
 
Exhibit B:   Affidavit Disclosing Interest in Property, under Government Code      
             Chapter 553, Subchapter A - 2 pages                                   
 
 
 
 
ADDITIONAL DISCLOSURE:  The Superintendent and any other employees identified by   
Board policy as being required to file the conflicts disclosure statement, in      
accordance with Local Government Code 176.003-.004, may access that form on the    
Texas Ethics Commission Web site at http://www.ethics.state.tx.us.                 
 
 
 
 
 
 





 
EXHIBIT A
 
 

AFFIDAVIT DISCLOSING SUBSTANTIAL INTEREST

 
 

IN A BUSINESS ENTITY OR IN REAL PROPERTY

 
 
STATE OF TEXAS                                                                     
 
 
COUNTY OF Cameron                                                                  
 
 
I, _____________________________(name), as an employee of Harlingen CISD, make this
affidavit and hereby on oath state the following:  I have a substantial interest   
in:                                                                                
 
 
[  ]  a business entity, as those terms are defined in Local Government Code       
      Sections 171.001-171.002, that would experience a special economic effect    
      distinguishable from its effect on the public by an action of the Board or   
      the District.  [See BBFA]                                                    
 
 
      or                                                                           
 
 
[  ]  real property for which it is reasonably foreseeable that an action of the   
      Board or District will have a special economic effect on the value of the    
      property distinguishable from its effect on the public.                      
 
 
The business entity or real property is (name/address of business or description of
property):                                                                         
________________________________________________________________________.          
 
 
I _________________________ have a substantial interest in this business entity or 
real property as follows:  (check all that apply)                                  
 
 
[  ]  Ownership of ten percent or more of the voting stock or shares of the        
      business entity.                                                             
 
 
[  ]  Ownership of ten percent or more of the fair market value of the business    
      entity.                                                                      
 
 
[  ]  Ownership of $15,000 or more of the fair market value of the business entity.
 
 
[  ]  Funds received from the business entity exceed ten percent of my gross income
      for the previous year.                                                       
 
 
[  ]  Real property is involved and I have an equitable or legal ownership with a  
      fair market value of at least $2,500.                                        
 
 
The statements contained herein are based on my personal knowledge and are true and
correct.                                                                           
 
 
 
 
Signed this ______ day of ____________________ (month), __________ (year).         
 
 
 
 
Signature of employee ______________________________________                       
 
 
Title ______________________________________                                       
 
 

ACKNOWLEDGEMENT

 
 
STATE OF TEXAS                                                                     
 
 
COUNTY OF Cameron                                                                  
 
 
Sworn to and subscribed before me on this ______ day of ____________________       
(month), __________ (year).                                                        
 
 
 
 
___________________________________, Notary Public in and for the State of Texas   
 
 
 
 
 
 
 
 
NOTE:  This affidavit should be filed with the Superintendent, Board President, or 
a designee before the Board takes action concerning the business entity or real    
property.                                                                          
 
 
 
 





 
EXHIBIT B
 
 

AFFIDAVIT DISCLOSING INTEREST IN PROPERTY

 
 
STATE OF TEXAS                                                                     
 
 
COUNTY OF Cameron                                                                  
 
 
I, _____________________________________________ (name), as Superintendent of      
Harlingen CISD, make this affidavit and hereby on oath state the following:        
 
 
I have a legal or equitable interest in property to be acquired with public funds, 
either by purchase or condemnation.                                                
 
 
The property is described as follows:                                              
 
 
_________________________________________________________________________.         
 
 
The nature, type, and amount of interest, including but not limited to percentage  
of ownership, I have in the property is:                                           
 
 
_________________________________________________________________________.         
 
 
The interest was acquired on ___________________________ (date).                   
 
 
I swear that the information in this affidavit is personally known by me to be     
correct and contains the information required by Section 553.002, Government Code. 
 
 
Signed this ______ day of ____________________ (month), __________ (year).         
 
 
 
 
Signature of Superintendent ________________________________________               
 
 
 
 

ACKNOWLEDGEMENT

 
 
STATE OF TEXAS                                                                     
 
 
COUNTY OF Cameron                                                                  
 
 
   BEFORE ME, ________________________________________ (here insert the name and   
character of the officer administering the oath) on this day personally appeared   
________________________________________ (affiant) known to me (or proved to me on 
the oath of _________________________ or through _________________________         
[description of identity card or other document]) to be the person whose name is   
subscribed to the foregoing instrument and acknowledged to me that he executed the 
same for the purposes and consideration therein expressed.                         
 
 
   Given under my hand and seal of office this ______ day of ____________________  
(month), __________ (year).                                                        
 
 
 
 
_____________________________________, Notary Public in and for the State of Texas 
 
 
 
 
NOTE:  This affidavit should be filed with the county clerk(s) within ten days     
before the date on which the property is to be acquired, as provided by Government 
Code 553.002.                                                                      
 
 
 

 

 

DATE ISSUED: 11/29/2005
UPDATE 77
DBD(EXHIBIT)-A

 

This online presentation of your district's policy is an electronic representation of TASB's record of the district's currently adopted policy manual. It does not reflect updating activities in progress. The official, authoritative manual is available for inspection in the office of the Superintendent. [See BF (LOCAL) for further information.]