Disclosure Election_PZ_EDC_Warren_2024

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ELECTION ON DISCLOSORE FOR CITY APPOINTEES An appointee of the City may choose whether or not to allow public access to the information in the custody of the City relating to home address, home telephone number, cellular and pager numbers (if not paid for by City), social security number, emergency contact information, and information that reveals whether the person has family members. Each individual shall state his/her choice in writing to the City Secretary's Office. If one elects not to allow public access to this information, the information is protected by Sections 552.024 and 552.117 of the Public Information Act and rulings of the Texas Attorney General. If a board member fails to report his/her choice, the information may be subject to public access. A board member may request to close or open public access to the information by submitting a written request to the City Secretary's Office. Only the City Secretary's Office is allowed to disclose the information listed and ONLY after verifying whether or not public access has been granted through use of this form. (Please strike through any information that you do not wish to be made accessible to the public) DO elect public access to my: (please indicate items you would like available, if any) v home address Vii,nme telephone number Cell or pager numbers (if not paid for by the City) Emergency contact information _ Social security number Information that reveals whether I have family members. I DO NOT elect public access to my home address, home telephone number, cell or pager numbers, emergency contact information, social security number, or information that reveals whether I have family members. Please complete the information below and return to the City Secretary's Office within fourteen days of receipt. Signature Date 4F/�RO "'�gtR2�. Printed Name *Email addresses of a member of the public that are provided for the purpose ofwannunicating electronically with a governmental body are confidential and not subject to disclosure under Government Code Section 552.137, however, email addresses received for contractual, business negotiations, or licensing applications, and those that are already made available to the public are generally not protected in the same manner.