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Yingling, Nancy-AP 2017-01-182-21 Prescribed by Secretary of State Section 141.031, Chapters 143 and 144, Texas Election Code 1/2017 ALL INFORMATION IS REQUIRED TO BE PROVIDED UNLES$ INQJCATED OATIONAI APPLICATION FOR A PLACE ON THE O O I J 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 ,v ' �L G© ND [FULL 1:1 U/VL UNEXPIRED FULL NA First, Middle, Last) PRINT NAME AS YOU WANT�ITOAPPEAR7N THE BALLOTl aim 1,h �� PERMANENT RESIDEN E A DESS (D t include P.O. Box or Rural PUBLIC MAILING ADD S C mpaig ailing addr ss, if available.) Route. If you do not have a residence address, describe the address at which you receive personal mail and location of residence.) �- CITY (,0,DPt-0 STAT 75-0ZIP 19 CITY � ST E —✓`X/� ZIP 75/`//(/—' V l PUBLIC EAAAIL ADDRESS (If available) OCCUPATION (Do not leave blank) DATE OF BIRTH VOTER REGISTRATION VUID NUMBER (Optional) Z ACc� 114X. oV y� j k CvnSV4aq4 _ `j �a7/6 IOB13111v TELEPHONE CONTACT INFORMATION (Optional) LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN IN STATE IN TERRITORY FROM WHICH THE Home: OFFICE SOUGHT IS ELECTED Work: 3-0—year (s) E� year (s) Cell: /y—_7 6' 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. _ t Before me, the undersigned authority, on this day personally appeared (name) Navlw �4 who being by me here and now duly sworn, upon oath says: ��// "I, (name) 1^/1 i'n of D -VIA -o- County, Texas, being a candidate for the office o swear that I will support and defend the Constitution and laws of the United States and of the Atatp of Texas. I am a citizen 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 true and correct." Xr SIGN orn to and subscribed before me at this the _ ay of EMMUMI I LL M'y Commisxpires J lune 1, �12U1'7 r ignature of Officer Administering Oath Title of Officer Adminis ri 0 BE COMPLETED BY CITY SECRETARY OR SECRETA Y OF OARD: (See Section 1.007) Q Date fteceiv&d SI ature of Secretary Voter Registration Status Verified Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512)463-5800 (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 MSI IMR FIRST MI OFFICE USE ONLY NAME Acct. # 5��,/��� NAM NICKE . LAST U SUFFIX Date Received ` e 3 CANDIDATE MAILING ADDRESS /PO BOX; A SUITE#; CITY; STATE; ZIP CODE ADDRESS t.�l' o (� 60 42:&/ '7—X r/ 0 P 4 CANDIDATE 1 AREA CODE PHONE NUMBER EXTENSION Date Hand delivered or Postmarked PHONE p] q ` -7 a,j� _ Le my (�! — / ! (� ` r/}I J Q&IM Dale Processed 5 OFFICE HELD �', Date Imaged (if any) ""t 6 OFFICE SOUGHT known) n J (if L 7 CAMPAIGN MS RV FIRST MI NICKNAME LAST SUFFIX TREASURER NAME ",Zt,Le Vd 8 CAMPAIGN STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE; ZIP CODE — TREASURER STREET ADDRESS residence or business () � Q �i t �\ 9 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION TREASURER PHONE - Le 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 am aware of the restrictions in title 15 of the Election Code on contributions from corporations and labor organizations. 11,�L ,I/1 ?/// Signature of dida Date Sig ed GO TO PAGE 2 wwmethics.state.N.us Revised 07/14/2010 Texas Ethics Commission P.O. Box 12070 Austin. Texas 78711-2070 (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 Dale Received political committee is encouraged to subscribe to the Code of Fair p Q Campaign Practices. The Code may be filed with the proper filing l l 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 Fair Campaign Practices is whintary. Date Processed Dale Imaged 1 ACCOUNT NUMBER 2 TYPE OF FILER (Ethics Commission Filers) CANDIDATE 1 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 TITLE (Dr., Mr., Ms., etc.) FIRST MI (PLEASE TYPE OR PRINT) �/ am.0j . . . . . . . . NICKNAME LAST . . . . . . . . . . . . . . . . . . SUFFIX (SR., JR., III, etc.) In(,1//1 rt 4 TELEPHONE NUMBER AREA CODE ONENUM &E EXTENSION OF CANDIDATE (PLEASE TYPE OR PRINT) '� "" `/ 1Y) 5 ADDRESS OF CANDIDATE STREET/POBOX; APT/SUITE#; CITY; STATE; ZIP CODE (PLEASE TYPE OR PRINT) b o b �,� ��` 6'0P'a1TY _ f / 1 6 OFFICE SOUGHT BY CANDIDATE (PLEASE TYPE OR PRINT) �d f rl C_1y ICJ P 5 111 v w 7 NAME OF COMMITTEE (PLEASE TYPE OR PRINT) 8 NAME OF CAMPAIGN TITLE (Dr., Mr., Ms., etc.) FIRST MI TREASURER ` i (PLEASETYPE OR PRINT) �/` -/]' ./. �S .l. NICKNAME LAST Va 1e—, !I *i ne— SUFFIX (SR., JR., III, etc.) GO TO PAGE 2 www.ethics.state.tx.us Revised 11/23/2010 ICXaS CIHIG5 UUMM1551UH r. V. Dox ILu/u iiu5un, iexas toti-/-uiu to 1L)403 -06W CODE OF FAIR CAMPAIGN PRACTICES There are basic principles ofdecency, 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 free and untrammeled choice and the will ofthe people may be fiilly and clearly expressed on the issues. (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 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 free elections or that hampers or prevents the Rill and free expression ofthe will ofthe 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 from 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. SignaftG Date www. ethics. state. tx.us Revised 11/23/2010 Texas Ethics Commission P.O. Box 12070 Austin. Texas 78711-2070 (512)463-5800 (TDD 1-800-735-29891 AMENDMENT: FORM ACTA CANDIDATE MODIFIED REPORTING DECLARATION PG 2 13 CANDIDATE ^ NAME W / 1 v/ 1 14 MODIFIED 7771 REPORTING COMPLETE THIS SECTION ONLY IF YOU ARE DECLARATION CHOOSING MODIFIED REPORTING •• This declaration must be filed no later than the 30th day before the first election to which the declaration applies. •- •• The modified reporting option is valid for one election cycle only. •• (An election cycle includes a primary election, a general electron, and any related runoffs.) •• Candidates for the office of state chair of a political party may NOT choose modified reporting. -- I do not intend to accept more than $500 in political contributions or make more than $500 in political expenditures (excluding filing fees) in connection with any future election within the election cycle. I understand that if either one of those limits is exceeded, I will be required to file pre-election reports and, if necessary, a runoff report. Year of election(s) or election cycle to Signatur of n ida which declaration applies This appointment is effective on the date it is filed with the appropriate filing authority. www.ethics.state.tx.us Revised 07/14/2010