MF Application for BallotPrescribed by Secretary of State
Sections 141.031, 143.004, 143.006, Texas Election Code
AU Information is required to be provided unless indii as optional. I I H#-
APPLICATION FOR A PLACE ON THE CITY OF 1 eo one) I , K GENERAL ELECTION BALLOT r I 1
TO: City Secretary 1
I request that my name be placed on the above-named official ballot as a candidate for the office indicated below.
OFFICE SOUGHT Include any place number or other distinguish& number, if any. I INDICATE TERM
1
PERMANENT RESIDENCE ADDRESS (Street address and MAILING ADDRESS (If different firom residence address)
number. If none, describe location of residence. Do not
Copp I/ C;+y Ca drc; I , ?/ru 6
Box or Rural ~t.).
a FuLL wuNEmIRED
I
CITY STATE ZIP I STATE
GPW' 7Y 3Ser9
EMAII: ADDRESS (Optional)
7< z5solq
OCCUPATION (Do not le ' e blank) DAm OF BIRTH VOTER REGISTRATION VUID NUMBER
mfvkw\~~:~ Q ~;R~*c:J 7 (if applicable)
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TELEPHONE NUMBE#(Include area code) (Optional) I I Length of Continuous Residence as of Date Application Sworn
1
oFnce: 972 - ~3fj-6~0~ I I rn STATE I IN CITY I rn DISTRICT oFtPREcrNcT1 I
HOME: q7Zr7ps- b934 I( 'ky@) 12 V(S) !L Y~(s) 7 mos I Imos I Lmos
I I I I If using a nickname as part of your name to appear on the ballot, you are also signing and swearing to the following statements: I flather I (
swear that my nickname does not constitute a slogan nor does it indicate a political economic, social, or religious view or affiliation. I have
been commonly known by this nickname for at least three years &or to this election. I I
Before me, the undersigned authority, on this
here and now duly sworn, upon oath says:
County, Texas, being a candidate for the office
defend the Constitution and laws of the United
the Constitution and laws of this state. I have
citizenship restored by other official action.
mentally incapacitated or partially mentally incapacitated without thy right to vote. I am aware of the nepotism law, Chapter 573, Government Code.
I fiuther swear that the foregoing statements included in my
Swogrq and subscribed before me at 4: o 9-
Wlicatibn a~ in all things true~pd pqeH
TO BE COMPLETED BY CITY SECRETARY:
(See Section 1.007)
-. -?
I
Texas Ethics Commission P.O. Box 12070 Austin, Texas 7871 1-2070 (512) 4635800 (TDD 4-800-735-2989) ,
APPOINTMENT OF A CAMPAIGN TREASURER FORM CTA
BY A CANDIDATE I PG I
12 CANDIDATE
See CTA lnstructlon Guide for detailed Instructions.
3 CANDIDATE
MAILING
ADDRESS
1 Total pages filed:
4 CANDIDATE
PHONE
5 OFFICE I HELD
(if any)
6 OFFICE
SOUGHT
(if known)
7 CAMPAIGN
TREASURER
NAME
8 CAMPAIGN
TREASURER
STREET
ADDRESS
AREA CODE PHONE NUMBER EXTENSION
771- g93"i (472,)
FIRST MI M. Ma.c~;w
..... . . . Lns~""" SUFFIX ' ' '
mi.
ADDRESS I PO BOX. APT I SUITE #, CITY, STATE, ZIP CODE
53Y LC Sf.
f, 7SJ'c
Cpp"/ 6.f y Ld~~:i / PI- 6
MSlMR FIRST MI NICKNAME LAST SUFFIX
OFFICE USE ONLY
Acct 11:
,
Date Received
-*-a, - EL~C~ d;3
FEB 0 6 20i2
STREET ADDRESS (NO PO BOX PLEASE); APT I SUITE R CIW STATE: ZIP CODE
I (residence or business) I I
9 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
10 CANDIDATE
SIGNATURE I am aware of the Nepotism Law, Chapter 573 of the Texas Government Code.
I am aware of my responsibility to file timely reports as required by title 15 of
the Election Code. I
I am aware of the restrictions in title 15 of the Election Code on contributions
Signature of CandCdat Date Signed
I GO TO PAGE 2 I
Revised 07/14/2010
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (51 2) 463-5800 (TDD 1 -800-7352989)
I
CODE OF FAIR CAMPAIGN
PRACTICES
FORM CFCP I
OFFICE USE ONLY
Pursuant to chapter 258 of the Election Code, every candidate and DateRecalved
political committee is encouraged to subscribe to the Code of Fair
Campaign Practices. The Code may be filed with the proper filing
authority upon submission of a campaign treasurer appointment I
form. Candidates or political committees that already have a I -
current campaign treasurer appointment on file as of September 1,
1997, may subscribe to the code at any time.
Subscription to the Code of Fair Campaign Practices is voluntary.
Date ldaged/
1 ACCOUNT NUMBER
(Ethics Commission Filers)
( 2 TYPE OF FILER I CANDIDATE d POLITICAL COMMITTEE
I If filing as a candidate, complete boxes 3 - 6, If filing for a political committee, cwnplete
then read and sign page 2. boxes 7 and 8, then read and sign page 2.
3 NAME OF CANDIDATE FIRST
(PLEASE TYPE OR PRINT)
..................... 1 NICKNAME .I LAST
................
SUFFK(SR.. JR.. Ill. etc.)
4 TELEPHONE NUMBER I AREA CODE PHONE NUMBER EXTENSION
OF CANDIDATE
(PLEASE TYPE OR PRINT)
5 ADDRESS OF CANDIDATE STREET I PO BOX; APT 1 SUITE#; UP COOE
(PLEASETYPE OR PRINT)
6 OFFICE SOUGHT
BY CANDIDATE
(PLEASETYPEOR PRINT)
7 NAME OF COMMITTEE
(PWSE TYPE OR PRINT)
8 NAME OF CAMPAIGN TITLE (or@ Ms. e.k)
TREASURER
(PLEASE TYPE OR PRINT) ........... .................
NICKNAME SUFFlX(SR., JR.. Ill, etc.) .
GO TO PAGE 2
Revised 11/23/2010
Texas Ethics Commission P.O. Box 12070 Austin, Texas 7871 1-2070 (51 2) 463-5800 (TDD 1-800-7352989) 1
CODE OF FAIR CAMPAIGN PRACTICES
There are basic principles of decency, honesty, and fair play that every candidate and political committee in this state
has a moral obligation to observe and uphold, in order that, after vigorously contested but fairly conducted campaigns,
our citizens may exercise their constitutional rights to a fiee and untrammeled choice and the will ofthe people may be
My and clearly expressed on the issues.
THEREFORE:
(1) I will conduct the campaign openly and publicly and limit attacks on my opponent to legitimate challenges to my
opponent's record atid stated positions on issues.
(2) I will not use or permit the use of character dehnation, whispering campaigns, libel, slander, or scurrilous attacks
on any candidate or the candidate's personal or fdy life.
(3) I will not use or permit any appeal to negative prejudice based on race, sex, religion, or national origin.
(4) 1 will not use campaign material of any sort that misrepresents, distorts, or otherwise falsifies the facts, nor will I
use malicious or unfounded accusations that aim at creating or exploiting doubts, without justification, as to the
personal integrity or patriotism of my opponent.
(5) I will not undertake or condone any dishonest or unethical practice that tends to corrupt or undermine our system
of fke elections or that hampers or prevents the full and fi-ee expression of the will ofthe voters, including any
activity aimed at intimidating voters or disco- them hm voting.
(6) I will defend and uphold the right of every qualified voter to 1I1 and equal participation in the electoral process,
and will not engage in any activity aimed at intimidating votas or discouraging them hm voting.
(7) 1 will immediately and publicly repudiate rnetl!ods and tactics that may come h others that I have pledged not
to use or condone. I shall take firm action against any subordinate who violates any provision of this code or the
laws governing elections.
I, the undersigned, candidate for election to public office in the State of Texas or campaign treasurer of a political
committee, hereby voluntarily endorse, submi to, and solemnly pledge myselfto conduct the campaign in accordatlce
with the above principles and practices. I
Date
www.ethics.state.tx.us Revised 11/23/2010