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Long, Cliff-AP 2017-01-182-21 Prescribed by Secretary of State Section 141.031, Chapters 143 and 144, Texas Election Code 12/2015 All information is required to be arovided unless indicated as optional. APPLICATION FOR A PLACE ON THE Com!? 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.) INVTERM FULL ❑ UNEXPIRED FULL NAME (First, Middle, Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT Fdve L!rlv&b La (2 e Latv PERMANENT AESIDENCE ADDRESS (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.) /s / 7"&e5 ry -I ::577 CITY STATE ZIP CITY STATE ZIP 7<01 L1©L 75'0 PUBLIC EMAIL ADDRESS (If available) OCCUPATION (Do not leave blank) DATE OF BIRTH VOTER REGISTRATION VUID �US/�✓/��S ©W�✓�=` NUMBER (Optional)' �oi✓ �sbvFccr�ci✓ c� .� . .o �/ / 08/� �0 19'i1(Pb `131 TELEPH E CONTACT INFORMATION (Optional) LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN Home: IN STATE IN TERRITORY ELECTED FROM Work: year (s) �(� year (s) Cell: Z 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) C C.(rr L6AJ67 who being by me here and now duly sworn, upon oath says: "I, (name)// -'F Z.oAJC of S County, Texas, being a candidate for the office of�QDu�G L %i -c /_' / swear that I will support and defend the Constitution and laws of the United States and of the State 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." X S orn to and subscribed before me at this the /2;!A- day of JEAN WIN my.Cornnnis§ion Ex do -� rVJune 16; 2011 —.a ,, ignature of Officer AdministeringOat 2 Title of Off ic r Admi TO BE COMPLETED BY CITY SECRETARY OR SECRETARY OF BOARD: (See Section 1.007) O Date OeceiJed ignature of Secre ar Voter Registration Status Verified (p= I 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 MS/MRS/MR FIRST I OFFICE USE ONLY NAME �LIJ Acct. # NICKNAM. .E . . . . . . . . LAST . . . . . . . . . . . . . . . SUFFIX . . . . L,OW`- 4 Dale Received 0kItS4 I'1 asp 3 CANDIDATE ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE MAILINGn ADDRESS 4slZ llocesTOA✓ 5T COP "(.L-�� 75'0(9 4 CANDIDATE AREA CODE PHONE NUMBER EXTENSION Dale Hand -delivered or Postmarked PHONE R3 9 L70 Date Processed (0/71) 5 OFFICE HELD //�� C,A0i?LL CI rrY �puNu �- Date Imaged (if any) 6 OFFICE SOUGHT %� known) cfe- Ca Pp/�a" 0, r4 `rpnlCi L (if I 7 CAMPAIGN 7 MS/MRS/MR FIRST MI NICKNAME AST SUFFIX TREASURER J r� NAME ,14 8 CAMPAIGN STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE; ZIP CODE TREASURER_ STREET�-0acL p n ! 7 Dl ADDRESS (residence or business) 9 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION TREASURER PHONE (g771) 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. am aware of the restrictions in title 15 of the Election Code on contributions from corporations and labor organizations. Si ature of Candidate Date Signed GO TO PAGE 2 www.ethics.state.tx.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 Date Received political committee is encouraged to subscribe to the Code of Fair LCA I I P 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. Dale Processed Subscription to the Code of Fair Campaign. Practices is volinataq. Date Imaged 1 ACCOUNT NUMBER 2 TYPE OF FILER (Ethics Commission Filers) CANDIDATE Rr 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) NICKNAME LAST SUFFIX(SR., JR., III, etc.) (2 Li Fir 1-o 416 4 TELEPHONE NUMBER AREA CODE PHONE NUMBER EXTENSION OF CANDIDATE a /%� ( / 393- / 9-0 (PLEASE TYPE OR PRINT) " 5 ADDRESS OF CANDIDATE STREET/ PO BOX; APT/SUUIITE#; CITY; e- STATE; ZIP CODE G r_T/ -7s'ei (PLEASE TYPE OR PRINT) , /�, / f��r✓S�N J i C.�Q14r /P 6 OFFICE SOUGHT BY CANDIDATE �p OArcL Ci 1rr, ���� (PLEASE TYPE OR PRINT) 7 NAME OF COMMITTEE (PLEASE TYPE OR PRINT) 8 NAME OF CAMPAIGN TITLE (Dr., Mr., Ms., etc.) FIRST MI TREASURER (PLEASE TYPE OR PRINT) . . . . . . . . . . . . . . ��.. . . . . . . . . . . . . . . . . . . . . . . . . . . NICKNAME LAST SUFFIX (SR., JR., III, etc.) GO TO PAGE 2 www.ethics.state.tx.us Revised 11/23/2010 texas CUucs t urrrrnlsslon t -.V. cox lLU/V HUsun, Texas f o t I I-ZU/U (n"1Z)403-0bUU ( 1 UU l-buu- CODE OF FAIR CAMPAIGN PRACTICES There are basic principles of decency, honesty, and fair play that every candidate andpolitical committee in this state has amoral obligation to observe anduphold, in orderthat, aftervigorously contested but 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 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 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 full and free expression ofthe 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. /1" . Signature Date www.ethics.state.tx.us Revised 11/23/2010