Rosemary Scott - Place 3AW2-15, 7/2011
Prescribed by Secretary of State
Sections 141.031, 143.004, 143,006, Texas Election Code
All information is required to be provided unless indicated as optional-
APPLICATION FOR A PLACE ON THE CITY OF GENERAL ELECTION BALLOT
TO: City Secretary
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
FULL UNEXPIRED
L
FULL NAME (First, Middle, Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT
a
PEPJAANENT RESIDENCE ADDRESS (Street address and apartment
MAILING ADDRESS (if different from residence address)
number. If none, describe location of residence. Do not include P.O,
Box or Rural Rt.)
CITY STATE ZIP CITY STATE ZIP
ij
EMAIL ADDRESS (optional) OCCUPATION (Do not leave blank) DATE OFBIRTH VOTER REGISTRATION VUEDNUMBER
- , 'N � -, - (if applicable)
f
V
TELEPHONE NUMBER (Include area code) (Optional)
Length '1011S Residence as of Date Application Sworn.
OFFICE:
IN STATE IN CITY IN DISTRICT OR PRECINCT'
yr(S) r-1 yr(S) YT(S)
HOME: -L c
MOS mos Inos
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 flu-ve years prior to this election.
Before me, the undersigned authority, on this day ptrsonallyaTpeared (name) who being by me
LI-11 �
I
here and now duly sworn, upon oath. says: "L (name) ti.LL of � -I , -
swear that I will support and
County, Texas, being a candidate for the office of
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 fall 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 farther swear that the foregoing statements included in my application are in all things true and correct"
X
SICYNATURBQF CANDIDATE
day of
Swo i to and subs-A ed before -a' this the
SEAL
(I NkA
AR-17ture of Offlie-T administering oaths Title of kfficer administering oal
TO BE COMPLETED BY CITY SECRETARY:
(See Section 1.007)
Date Received `- — Signature of ity
�—AA 0; 7n rFi o%das -FRnn (TED 1 -800- 735 -2989)
Texas Ethics Commission mu. oux 1 -1 u I, .. - I -
APP®INTMENT OF A CAMPAIGN TREASURER FORM CTA
BY A CANDIDATE PG 1
1 Total pages Bled:
See CTA Instruction Guide for detailed instructions.
1
MS /MRS /MR FIRST MI
OFFICE USE ONLY
2 CANDIDATE
NAME
Acct #
—° — ° -- SUFFIX
NICKNAME LAST
'
Date Received
^alt
3 CANDIDATE
ADDRESS I PO BOX;. APT / SUITE # CITY; STATE; ZIP CODE
MAILING
d i
ADDRESS
fj 60
4 CANDIDATE
AREA CODE PHONE NUMBER EXTENSION
Dale Hand- denveredor Postmarked --
PHONE
Date Processed
C\ t
Date Imaged
5 OFFICE
HELD,
(if any)
6 OFFICE
SOUGHT
-dam a f °¢ `c' .3
(if known)
%"
7 CAMPAIGN
MS/MRS/MR FIRST MI NICKNAME LAST SUFFIX
TREASURER
NAME
STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE#; CITY; STATE; ZIP CODE
a CAMPAIGN
TREASURER
_
STREET
-°
ADDRESS
(residence or business)
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 am aware of the restrictions in title 15 of the Election Code on contributions
from corporations andlabor organizations.
}P
Signature of Candidate ate Signed
GO TO PAGE 2
www.ethIcs.state.tX,US
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CODE OF FAIR CAMPAIGN
FORM CFCP
COVER SHEET
r
C l lC
OFFICE USE ONLY
Pursuant to chapter 25 8 of the Election Code, every candidate and
Date Received
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 -
form. Candidates or political committees that already have a
current campaign treasurer appointment on fife as of September 1,
Date Hand-delivered orPostmarked
1997, may subscribe to the code at any time.
Date Processed
Subscription to the Code of Fair Campaign Practices is voluntary.
Data Imaged
1 ACCOUNT NUMBER
2 TYPE OF FILER
(Ethics Commission Flers)
CANDIDATE R, / 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
THE (Dr., Mr., Ms, etc.) FIRST
MI
(PLEASE TYPE ORPRINT)
NICKNAME LAST
SUFFIX (SR., JR., III, etc)
� F
B
4 TELEPHONE NUMBER
AREA CODE PHONE NUMBER
EXTENSION
OF CANDIDATE
`J a
t
(PLEASE TYPE OR PRINT)
5 ADDRESS OF CANDIDATE
STREET I PO BOX; APTIsUITE� CrrY;
STATE; ZIP CODE
(PLEASETYPE OR PRINT)
r'
6 OFFICE SOUGHT
BY CANDIDATE
(PLEASETYPEORPRIN-Q
7 NAME OF COMMITTEE
(PLEASETYPEOR PRINT)
8 NAME OF CAMPAIGN
TITLE (Dr., Mr, Ms „etc) FIRST
MI
TREASURER
n,
(PLEASE TYPE OR PRINT)
NICKNAME LAST
SUFFIX(SR., JR., III, eta)
'
0 K I
GO TO PAGE 2
www.ethlcs.state.N.us Revised 11/2312010
I CJiGJ cU UU-,o[nmisslon t-.U. box IZU /U Husun, Texas IbfI1 -ZU /U (bl L)4ba -bdUU (IUU "I -buu-
There arebasic principles of decency, honesty, andfairplaythat every candidate andpolitical committee inthis state
has amoral obligationto observe anduphold, inorderthat, after vigorously contest edbutfairly conducted campaigns,
our citizens may exercise their constitutional rights to a free anduntrammeled choice andthe will of-the people maybe
fully and clearly expressed ofthe issues.
III' • ) '
(1) I will conduct the campaign openly and publicly and limit attacks on my opponentto legitimate challenges to my
opponent's record and statedpositions on issues.
(2) Iwillnotuse orpermitthe 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 orpennit any appeal to negative prejudice based onrace, 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 orpattiotism ofmy opponent.
(5) I wilinotundertake or condone any dishonest orunethical practice thattends to corrupt orundermine our system
of free elections or that hampers orprevents the full and free expression of the will ojf the voters, including any
activity aimed atintimidating voters or discouraging them from voting.
(6) I will defend andupholdthe right of every qualified voterto 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 andpublicly 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 anyprovision 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, herebyvoluutarily endorse, subscribeto, andsolemnlypledgemyselftoconduct the campaigninaccordance
withthe aboveprinciples andpractices.
< -�( Ti
Signature
n,
Date
www.ethics.state.tx.us Revised 11123/2010