Robin Thompson - Place 5AW2 -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
0
FULL UNEXPIRED
FULL NAME (First, Middle, Last)
PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT
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y
PERMANENT 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
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EMAIL ADDRESS (Optional)
(optional)
OCCUP IT Q1 not leave blank)
DATE OF BIRTH
VOTER REGISTRATION VUID NUMBER
�c., �. �,� ,, < ,
(if applicable)
TELEPHONE NUMBER (Include area code) (Optional)
Length of Continuous Residence as of Date Application Sworn
OFFICE:
IN STATE IN CITY IN DISTRICT OR PRECINCT'
2 c,
yr(s) yr(S) yr(s)
HOME: L, _
mos mos mos
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) } i ` of i c\. A/ 4:
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 6e State k 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."
'gyp BRENDA LOUISE DENNIS )
NOTARY PUBLIC
STATE Of TEXAS tW� r SIGNATURE CANDIDATE
S this the �� F" i> LS day of
�.. SEAL
Signa e of Officer administering oath' y Title of Officer administering bath
TO BE COMPLETED BY CITY SECRETARY:
(See Section 1.007)
Date Received. Signature of City Secretary
Tro — Mki— rr,,., —l—i— P n Rnv 1 9n70 Ai actin TAYAS 78711 -2(170 (512) 463 -5800 ITDD 1- 800 - 735 -2989)
APPOINTMENT OF A CAMPAIGN TREASURER FORM OTA
BY A CANDIDATE PG 1
1 Total pages filed:
See CTA Instruction Guide for detailed instructions.
2 CANDIDATE
MS / MRS I R FIRST Mi
OFFICE USE ONLY
NAME
tCi C
Acct. #
NICKNAME LAST SUFFIX
Dale Received
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3 CANDIDATE
ADDRESS / PO BOX; APT I SUITE #; CITY; STATE; ZIP CODE
MAILING
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ADDRESS
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4 CANDIDATE
AREA CODE PHONE NUMBER EXTENSION
Date Hand -delivered orPostrnarked
PHONE
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Dale Processed
b OFFICE
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(if known)
7 CAMPAIGN
MS /MRSI MI NICKNAME LAST SUFFIX
TREASURER
(�^^FIRST
C- RAC E
NAME
8 CAMPAIGN
STREET ADDRESS (NO PO BOX PLEASE);_ APT / SUITE #; CITY; STATE; ZIP CODE
TREASURER
\
C
STREET
ADDRESS
(residence or usine
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9 CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
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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.
Signature of Candidate Date Signed
GO TO PAGE 2
www.ethics,state,tx.us Revised 07/1412010
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711 -2070 (512) 463 -5800 (TDD 1- 800 - 735 -2989)
CUCIDE 0" F 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
Campaign Practices. The Code may be filed with the proper filin g
j
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.
Dale Processed
Date Imaged
1 ACCOUNT NUMBER
2 TYPE OF FILER
(Ethics Commission Filers)
CANDIDATE n 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. 8 Ms., etc.) FIRST MI
(PLEASE TYPE OR PRINT)
NICKNAME LAST SUFFIX (SR., JR., III, etc.)
A
"),
1
4 TELEPHONE NUMBER
AREA CODE PHONE NUMBER EXTENSION
OF CANDIDATE
,^��( `/ 1
C �" ' `
(PLEASE TYPE OR PRINT)
5 ADDRESS OF CANDIDATE
STREET/ PO BOX; APT /SUITE #; CITY; STATE; ZIP CODE
(PLEASE TYPE OR PRINT)
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,
6 OFFICE SOUGHT
��` ��� � ��oo c`i, P'GL(�
Y�
BY CANDIDATE
(PLEASE TYPE OR PRINT)
7 NAME OF COMMITTEE
- -��M�n (' G�'�� �L✓\C�` P�4 J�
(PLEASE TYPE OR PRINT)
8 NAME OF CAMPAIGN
TITLE (Dr., Mr., Ms., etc.) FIRST MI
TREASURER
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`.
(PLEASE TYPE OR PRINT)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
NICKNAME LAST SUFFIX (SR., JR., III, etc.)
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GO TO PAGE 2
www.ethics.state.tx.us Revised 11/23/2010
Texas ttnics uommission F.U. box 12U 1 U Austin, Texas /t tvj -LU /U (b9 L) 4b6 -bbUU (I UU 1-buu-
XM 13 MEM a WIN 11061111111 L 1
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 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 of the people may be
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 notuse orpermit 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 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 from voting.
(7) Twill 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 myself to conduct the campaign in accordance
with the above principles and practices.
Signature
0'7 -0( -r
Date
www.ethics.state.tx.us Revised 11/23/2010