Danielene Salas2 -21
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. Prescribed by Secretary of State
Section 141,031, Chapters 143 and 144, Texas Election Cade
1/2017
GENERAL ELECTIONBALLOT (("
APPLICATION FOR A PLACE ON THE
TO: City Secretary/Secretary of Board
N
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
{¢�
11
i � � FU LL
0 UNEXPIRED
FULL NAME (First, Middle, Last)
PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT'
PERMANENT RESIDENCE 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.)
CITY
E
ST TE
ZIP
���L �"' �i
CITY
STATE
ZIP
i 4V A
'i �j d�t r
� ^"IV� r.E., �.
✓!,
PUBLIC EMAIL ADDRESS (If available)
OCCUPATION (Do not leave blank)
DATE OF BIRTH
VOTER REGISTRATION VOID
NUMBER (Optional) z
,.v
( // lftf�
(�.1tiiC t
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:
year (s)
year (s)
Cell: /L . ` ,.w
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) °'` who being by me
here and now duly sworn, upon oath says:
"I, (name) �ra of �_ �> �T '� t,< _ County, Texas, being a
candidate for the office of U, „ - = t `dry _ , 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 prob jurisdiction to be totally mentally incapacitated or
partially mentally incapacitated without the right to vote. I am aware of the nepoti 1p , Chapter 573, Government Code.
1 �
r .F
I further swear that the foregoing statements included in my application ark ` I thin 's r an co°
X
SIGNATURE 0 A IDATE
Sworn to and subscribed before me at �� , og� �, , this the `` ' day of Lam: �; `'
SOMA R. SCHMOE
NOTARY PUBLIC
` ` �'
STATE OF TEXAS
(to My Commission Expires 12
Signature of Officer Administering Oath Title of Officer Administering Oath
TO BE COMPLETED BY CITY SECRETARY OKSECRETARY OF BOARD: i F
(See Section 1.007) `
Date Received Signature of Secretary
Voter Registration Status Verified
x -r
1.2019
T --- � 1 =0,i Pr) Rnx 1 ?n7n Ai mfin Texas 78711 -9n7O (512) 463 -5800 (TDD 1- 800 -735 -2989)
APPOINTMENT OF A CAMPAIGN TREASURER FORM CTA
BY A CANDIDATE PG 1
1 Total pages filed:
See CTA Instruction Guide for detailed instructions.
2 CANDIDATE
MS /MRS /MR FIRST MI
OFFICE USE ONLY
NAMED%
[
2 n
Acct. #
f € t
. . . . . . . . . . . . . . . . . . .
NICKNAME LAST SUFFIX
Dale Received
j�
-
?
3 CANDIDATE
ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE
MAILING
(4_'
ADDRESS
4 CANDIDATE
AREA CODE PHONE NUMBER EXTENSION
Date Hand -delivered or Postmarked
PHONE
Dale Processed
5 OFFICE
Date Imaged
HELD
^'
(if any)
6 OFFICE
SOUGHT
known
if
7 CAMPAIGN
MS/MRS /MR FIRSt MI NICKNAME LAST SUFFIX
TREASURER
NAME
8 CAMPAIGN
STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #, CITY; STATE; ZIP CODE
TREASURER
STREET,
ADDRESS
cc��
(residence or business)
9 CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
(IC
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.
lama ware th restrictions in title 15 of the Election Code on contributions
from cor tiois and labor organizations.
Signature o'f andidate 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)
CAMPAIGN CODE OF FAIR 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;F
Campaign Practices. The Code may be filed with the proper filing
, /A",
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 voluntary.
Date Processed
Date Imaged
1 ACCOUNT NUMBER
2 TYPE OF FILER
(Ethics Commission Filers)
CANDIDATE F-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)
. . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.
NICKNAME LAST SUFFIX (SR., JR., III, etc.)
JE6 -i - 1€'cf__
4 TELEPHONE NUMBER
AREA CODE PHONE NUMBER EXTENSION
OF CANDIDATE
(PLEASE TYPE OR PRINT)
1/ J
5 ADDRESS OF CANDIDATE
STREET IPOBOX; APT /S/U"ITE #, CITY; STATE; ZIP CODE
(PLEASE TYPE OR PRINT)
kE` ► !t,
6 OFFICE SOUGHT -
BY CANDIDATE
(PLEASE TYPE OR PRINT)
-`°
7 NAME OF COMMITTEE
(PLEASETYPEORPRINT)
C
y
i_U
8 NAME OF CAMPAIGN
TITLE (Dr., Mr., Ms., etc.) FIRST MI
TREASURER
(PLEASE TYPE OR PRINT)
1 A V� . C .
NICKNAME LAST SUFFIX(SR., JR., III, etc.)
[�
, -A.(
GO TO PAGE 2
www.ethics.state.tx.us Revised 11/23/2010
I CRCJS ClI IIL;Z:i UU1 I I I I IIS51UI 1 r.U. rsox -1zU /U r,usun, texas lorrj -LU /U (b "1 L) 4b.5 -0twu ( I uU -I- aUU- 1,30 -Zau
CODE OF FAIR CAMPAIGN PRACTICES
There are basic principles of decency, honesty, and fair play that every candidate and political committee inthis state
has amoral obligationto observe anduphold, in orderthat, aftervigorously contested but fairly conducted campaigns,
our citizens may exercise their constitutional rights to afree anduntrammeled choice andthe will ofthe people maybe
fully and clearly expressed on the issues.
TBEREFORE:
(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 permitthe 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 ofmy 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 fill and equal participation in the electoral process,
and will not engage many 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 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, subscribe to, and solemnly pledge myselfto conductthe campaigain accordance
with the above principles and practices.
t
Signature
Date
www,ethics.state.tx.us Revised 11/23/2010