Note: See the following pages for forms that may be used for compliance with disclosure requirements as defined in Local Government Code 171.002 and Government Code, Chapter 553, Subchapter A.

Exhibit A—Affidavit Disclosing Substantial Interest in aBusiness Entity or Real Property

STATE OF TEXASCOUNTY OF _____________________

I, ______________________________ (name), as a local public official of the _________________________ College District, make this affidavit and on my oath state the following:

I, or a person(s) related to me in the first degree, have a substantial interest as defined in Local Government Code 171.002 in:


The business entity or real property is: ___________________________________________________________________.

(name/address of business or description of property)

__________________________ ("I" or name of relative and relationship) (have)(has) a substantial interest in this business entity or real property as follows: (check all that apply)

The statements in this affidavit are based on my personal knowledge and are true and correct.

Upon the filing of this affidavit with the board's official record keeper, I affirm that I shall abstain from participation in any decision involving this business entity or real property, unless permitted according to Local Government Code 171.004(c).

Signature of official: ______________________________________

Title: ______________________________________

Date: ______________________________________


COUNTY OF _____________________

Sworn to and subscribed before me on this ______ day of ____________________ (month), ______ (year).

_____________________________________, Notary Public, State of Texas

Exhibit B—Affidavit Disclosing Interest in Property

STATE OF TEXAS COUNTY OF _____________________

I, ___________________________________ (name of affiant), (check one of the following:)

______________________________________ College District make this affidavit and on my 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 fully described as follows:


The nature, type, and amount of interest, including percentage of ownership, I have in the property is:


I acquired my interest in the property on __________________ (date).

The information stated in this affidavit is personally known by me to be correct and contains the information required by Government Code 553.002.

Signature of affiant: ______________________________________

Office or public title: ______________________________________

Date: ______________________________________

Note: This affidavit must be filed with the county clerk(s) of the county or counties in which the property is located and of the county in which the public servant or candidate resides within ten days before the date on which the property is to be acquired by purchase or condemnation.

Dallas College



DATE ISSUED: 3/24/2016