David Scagliola - Place 32 -22
Prescribed by Secretary of State
Section 141.031, Chapters 143, 144, and 201, Texas Election Code
12/2015
All information is required to be provided unless indicated as optional.
APPLICATION FOR A PLACE ON THE c116erZ SPECIAL 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.)
FULL NAME (First, Middle, Last)
PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT
-Y')�qaa L-
-DAVID 5046Z1DZA-
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
location
p ./
FDi�B��%Jie �/v
at which you receive personal mail and of residence.)
3 `// iy ,r_7a�(g�t /A� L -
CITY
STATE
ZIP
CITY
STATE
ZIP
SclyFn r7,-
7-
7e lV 8
%'x
-73108
PUBLIC EMAIL ADDRESS (If available)
OCCUPATION Do n t leave blank)
611 f
DATE OF BIRTH
VOTER REGISTRATION VUID
1
NUMBER (Optional)
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TELEPHONE CONTACT INFORMATION (Optional)
LENGTH OF CONTINUOUS RESIDENCE
AS OF DATE APPLICATION SWORN
Home:
1/go
IN STATE
IN TERRITORY ELECTED FROM
Work:
year (s)
/5 year (s)
Cell: V , 6-1 8. _ / L7 ! VI
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) - A U D S646- , who being by me
here and now duly sworn, upon oath says:
/�
"I, (name) pt U l b ��'« "� , of C 0,# D,4 G yPc County, Texas, being a
candidate for the office of cc' V, / G 1-5( , 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.
further swear that the foregoing statements included in my application are in t ings true and correct."
X
INGNAATUR
Sworn to and subscribed before me at this the of BRENDA LOUISE DENNIS
NOTA&RUBLIC
STATE OF TEXAS
Commission Expires 11-03-18
c
Sign of Officer Administering OathZ Title of OfficA Administering Oa
TO BE COMPLETED BY CITY SECRETARY OR SECRETARY OF BO D: A
(See Section 1.007) "
e Received "nature of Secretary
Voter Registration Status Verified
Tavac Pthin¢ f-_nmmiccinn P n Rnx 17n7n 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 R FIRST MI
OFFICE USE ONLY
NAME
Acct. #
...... ...............................
NICKNAME LAST SUFFIX
Date Received
3 CANDIDATE
ADDRESS / PO BOX; APT / SUITE #, CITY; STATE; ZIP CODE
MAILING
ADDRESS
��)
!( �Oxp3Rlf+A!./`(
4 CANDIDATE
AREA CODE PHONE NUMBER EXTENSION
Date Hand - delivered or Postmarked
PHONE
(ho)
Date Processed
5 OFFICE
Date Imaged
HELD
(if any)
6 OFFICE
SOUGHT
n
PICe
(if known)
1... GJ�
7 CAMPAIGN
MS /MRS/ R FIRST MI NICKNAME LAST SUFFIX
TREASURER
NAME
0e 0
8 CAMPAIGN
TREASURER
STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #, CITY; STATE; ZIP CODE
STREET
66
ADDRESS
�z Tx 78106
U
(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 rporations and labor organizations.
Signature date ate Signed
GO TO PAGE 2
www.ethics.state.tx.us Revised 07/1412010
TPYac Pthicc C..nmmiacinn Pn Rnx 1X170 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
Campaign Practices. The Code may be filed with the proper filing
auth ority upon submission of a campaign treasurer appointment
O I SE DE
WB:RINDA LOUISE )ENNIS
form. Candidates or olitical committees that ahead have a
p y
E of rE
current campaign treasurer appointment on file as of September 1,
on Fxp1� ,S 03 -i
1997, may subscribe to the code at any time.
Date Hand - delivered orPostrnarked
Date Processed
Subscription to the Code of Fair Campaign Practices is voluntary.
Date Imaged
1 ACCOUNT NUMBER
2 TYPE OF FILER
(Ethics Commission Filers)
CANDIDATE M 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
TITL (Drj;Mr.,Ms.,etc.) FIRST
MI
(PLEASE TYPE OR PRINT)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
NICKNAME LAST
. . . . . . . . . . . . . . . . . .
SUFFIX (SR., JR., III, etc.)
4 TELEPHONE NUMBER
AREA CODE PHONE NUMBER
EXTENSION
OF CANDIDATE
(PLEASE TYPE OR PRINT)
5 ADDRESS OF CANDIDATE
STREET /PO BOX; APT / SUITE #; CITY;
STATE; ZIP CODE
(PLEASE TYPE OR PRINT)
/
S y / /� � n //J roJ�!
U �/
6 OFFICE SOUGHT
BY CANDIDATE
�pd.JctL.�iE'�► $Ei� %�� c e-
(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
TPYAC Fthicc r.nmmicsinn PC) Rnx 1 ?r17n Austin- Texas 78711 -2070 (512) 463 -5800 (TDD 1- 800 - 735 -2989)
CANDIDATE MODIFIED FORM CTA
REPORTING DECLARATION PG 2
11 CANDIDATE
NAME
12 MODIFIED
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 election, 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 ofelection(s) or election cycle to Signal etC�rt&date
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
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711 -2070 (512) 463 -bBUU (I uu 1 -buu-
CODE OF FAIR CAMPAIGN PRACTICES
There are basic principles of decency, honesty, and fair playthat every candidate and political committee in this state
has amoral 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 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 j ustification, 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 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) 1 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 apolitical
committee, hereby voluntarily endorse, subscribe to, and solemnly pledge myself-to conductthe campaign in accordance
with the above principles and practices.
ignature Date
www.ethics.state.tx.us Revised 11/23/2010