Hill, Mark-AP 2017-01-182-21
Prescribed by Secretary of State
Section 141.031, Chapters 143 and 144, Texas Election Code
12/2015
nll :r.F..r.r.�4-11— 1, rangy rail +n La nr—ielarl unlacc inrlirntafl ac nntinnal
APPLICATION FOR A PLACE ON THE C, &PRI11 GENERAL ELECTION BALLOT
TO: City Secretary/Secretary of Board
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 distinguishing number, if any.)
INDICATE TERM
Y`1 WKY'
FULL
11 UNEXPIRED
FULL AME First, Middle, Last)
i �
o�' 1
PRIN NAME AS Y � T IT TO APPEAR ON THE BALLOT
PERMANENT RESIDENCE ADDRE S (Do not include a P.O. Box or Rural
PUBLIC MAILING ADDRESS (Campaign mailing address, if available.)
Route. If you do not have a residence address, describe the address
at which you receive personal mail and location of residence.)
�Dn S 41 W
CITY
STATS
ZIPA
CITY
STATE
ZIP
PUBLIC EMAIL ADDRESS (If available)
`
AW
OCCUPATION (Do not leave blank)
+
DATE OF BIRTH
VOTER REGISTRATION VUID
NUMBER (0�
TELEPHONE CONTACT INFORMATION (Optional) LENGTH OF CONTINUOUS RESIDENCE
AS OF DATE APPLICATION SWORN
Home: IN STATE
(s)
IN TERRITORY ELECTED FROM
(s)
Work: year
year
Cell: —month(s)
month(s)
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 further 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 prior to this election.
Before me, the undersigned authority, on this day personally appeared (name) M%6� V�)who being by me
here and now duly sworn, uponoat y
"I, (name) �^'� lf' , y` of 140"es County, Texas, being a
candidate for the office of swear that I will support and defend the Constitution and laws
of the United States and of the State of exas. I am a citiz n of the United States eligible to hold such office under the constitution and laws of
this state. I have not been finally convicted of a felony for which I have not been pardoned or had my full rights of citizenship restored by other
official action. I have not been determined by a final judgment of a court exercising probate jurisdiction to be totally mentally incapacitated or
partially mentally incapacitated without the right to vote. I am aware of the nepotism law, Chapter 573, Government Code.
I further swear that the foregoing statements included in my application are in all things and correct."
X
SIG AT
-ryworn to and subscribed before me at this the LRT— day of Jl&nLJa_
01 JEAN,bI&MELII
-'* (;0rn1 tis5itin Expires
11 JA 14-44J9 q441 Iry%. dJdne 1B, 017
ignature of Officer Administering Oath2 Title of Offic r Admi Bring `'Or
TO BE COMPLETED BY CITY SECRETARY OR SECRET Y OF BOARD: '
(See Section 1.007) ()1 %-1 /
Date ecelved nature of Secretary
Voter Registration Status Verified -* p 2 1,
on D_ li')n7n Anefin Tcvnc 78711-9n7n (51 9) 48 1-5800 (TDD 1-800-735-2989)
APPOINTMENT OF A CAMPAIGN TREASURER FORM CTA
BY A CANDIDATE PG 1
See CTA Instruction Guide for detailed instructions.
1 Total pages filed:
2 CANDIDATE
NAME
MS/MRS/MRFIRST MI
��• �kov 13
YLAST.
OFFICE USE ONLY
Acct. #
NICKNAME SUFFIX
•
1.
Date Received
0
3 CANDIDATE
MAILING
ADDRESS
ADDRESS /PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE
t\j�
1 1 on Y)KALW=
11% 70t q�l
r
4 CANDIDATE
AREA CODE PHONE NUMBER EXTENSION
Dale Hand -delivered or Postmarked
PHONE
/ry�^J �\ /,��VA—��1 J�
l_III
Date Processed
5 OFFICE
HELD
,
Dale Imaged
(if any)
6 OFFICE
SOUGHT
CoNd� ?L'A�
(if known)
7 CAMPAIGN
TREASURER
MS/MRS/MR FIRST MI NICKNAME LAST SUFFIX
NAME
W f'A r `
8 CAMPAIGN
STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE; ZIP CODE
TREASURER
STREET
ADDRESS
(residence or business)
V
9 CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
ak)
�n'—(A6�10
CANDIDATE
SIGNATURE
I am aware of the Nepotism Law, Chapter 573 of the Texas Government Code.
am aware of my responsibility to file timely reports as required by title 15 of
the Election Code.
I am aware of the restrictions in title 15 of the Election Code on contributions
from corporati and labor organizations.
1 41-7
Signature of Candidate D to igned
GO TO PAGE 2
www.ethics.state.N.us Revised 07/14/2010
-r .,,,,. L=+k; r�,,.,......Il,.., on Rnv igmn Anctin TP.YaR 7R711-2n7n (512)463-5800 (TDD 1-800-735-2989)
CODE OF FAIR CAMPAIGN FORM CFCP
PRACTICES COVER SHEET
OFFICE USE ONLY
Pursuant to chapter 258 of the Election Code, every candidate and
Date Received
political committee is encouraged to subscribe to the Code of Fair
0 1 I 1g 111 CW
Campaign Practices. The Code may be filed with the proper filing
authority upon submission of a campaign treasurer appointment
form. Candidates or political committees that already have a
current campaign treasurer appointment on file as of September 1,
Date Hand -delivered or Postmarked
1997, may subscribe to the code at any time.
Subscription to the Code of Fail- Campaign Practices is vohintaty.
Dale Processed
Date Imaged
1 ACCOUNT NUMBER
2 TYPE OF FILER
(Ethics Commission Filers)
CANDIDATE Ig POLITICAL COMMITTEE
If filing as a candidate, complete boxes 3 - 6, If filing for a political committee, complete
then read and sign page 2. boxes 7 and 8, then read and sign page 2.
3 NAME OF CANDIDATE
IT E Mr,, Ms.. etc.1 FIRST( MI
(PLEASE TYPE OR PRINT)
l
_ l
v
NICKNAME LAST SUFFIX (SR., JR., III, etc.)
4 TELEPHONE NUMBER
OF CANDIDATE
AREA CODE PHONE NUMBER EXTENSION
(0
(PLEASETYPEORPRINT)
` l/�1' 079--96F7
5 ADDRESS OF CANDIDATE
(PLEASETYPE OR PRINT)
STREET/ PO BOX; APT/SUITE4; CITY; STATE; ZIP CODE
P2�R
6 OFFICE SOUGHT
BY CANDIDATE
(PLEASE TYPE OR PRINT)
7 NAME OF COMMITTEE
(PLEASE TYPE OR PRINT)
8 NAME OF CAMPAIGN
TREASURER
TITLE(Dr.,Mr s., etc.) FIRSTM MI � ��
(PLEASE TYPE OR PRINT)yqf
`.'.V Y. 1.�. �.I. .". . .
NICKNAME LAST SUFFIX (SR., JR., III, etc.)
GO TO PAGE 2
www.ethics.state.N.us Revised 11/23/2010
IexaSt.inicsLommission r.u.box-ILUIU HUSUn, Texas tot I-ZU/U (0-IZ)4b6-0t5UU (IUU"I-buu-
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 anduphold, in order that, after vigorously contestedbut fairly conducted campaigns,
our citizens may exercise their constitutional rights to a free anduntrammeled choice and the will ofthe people maybe
fully and clearly expressed onthe 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 and stated positions on issues.
(2) I will not use or permit the use of character defamation, whispering campaigns, libel, slander, or scurrilous attacks
on any candidate or the candidate's personal or family life.
(3) I will not use or permit any appeal to negative prejudice based on race, sex, religion, or national origin.
(4) I will not use campaign material of any sort that nnisrepresents, distorts, or otherwise falsifies the facts, nor will I
use malicious or unfounded accusations that airn 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 corruptor undermine our system
of free elections or that hampers or prevents the full and free expression of the will of the voters, including any
activity aimed at intimidating voters or discouraging them from voting.
(6) I will defend and uphold the right of every qualified voter to full and equal participation in the electoral process,
and will not engage in any activity aimed at intimidating voters or discouraging them fi-om voting.
(7) I will immediately and publicly repudiate methods and tactics that may come from others that I have pledged not
to use or condone. I shall take firm action against any subordinate who violates any provision ofthis 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, subscribe to, and solemnly pledge myselfto conduct the campaign in accordance
with the above principles and practices.
A/90
Signature Date
www.ethics.state.tx.us Revised 11/23/2010