Angelina Kiser - Place 62 -21
prescribed by Secretary of Sta to
s-u.n 141.034 Chapters 143 and 144J"—Election C-de
]2/2015
^ APPLICATION FOR A PLACE ON THEW IC'_1� �1� (� /�I 1�1U GENERAL ELECTION BALLOT
TO: City Secretary/Secretary of Board
I requestthat 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.)
17�INDICATE TERM
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'
ElUNE
El 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.mailingaddress, if available,)
Route. If you do not have a residence address, describe the address
at which you receive personal mall and location of residence,)
CI Vi 1 '
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jq o cl 14 ber"E_ J ka I'Yl,
CITY
40,CCUPATION
CITY
STATE
ZIP
PUBLIC EMAIL ADDRESS (if available)
o not leave blank)
DATE OF BIRTH
VOTER REGISTRATION VUID
NUMBER (Optional)-'
okige',r ,sa+c, cc,Cpvv
TEL EPHONE CONTACT INFORMATION (Optional)
LENGTH OF CONTINUOUS RESIDENCE
AS OF DATE APPLICATION SWORN
Home; I b y • �� � —�G� 2U
IN STATE
IN TERRITORY ELECTED FROM
Work: �. I CJ -- � � Ci ) l -7L .
year (s)
4 / year (s)
Z 10 — Cell: �` _ 6(D�
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 leastthree years prior to this election,
�]
Before me, the undersigned authority, on this day personally appeared (name) who being by me
here and now dully sworn, upon oath says:
"I, (name) A no 1 `�`� of County, Texas, being a
candidate for the office of e ' w€ 2 11.' ( swear that I will support and defend the Consiitution-and laws
of the United States and of the State of Texas, am a citizen of the United States eligible to hold such office under the constitution and laws of
this slate. 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, l 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 thatthe foregoing statements Included in.my application ar In all things true and correct" r
SIGNATUR
�.�..
Sworn to and subscribed before me at- c �a this the me day of
®% BRENDA LOUISE DENNIS
NO$IW PUBLIC
STATE UE TEXAS
a
My Commission Wires 11.03 -1
Signature of Officer Administering Oath2 Title of Officer Administering Oath
TO BE COMPLETED BY CITY SECRETARY OR SECRETARY OF BOARD:
I,
'(See Section 1.007) l:..... t . `� E , k•'
Date Received Signature of Secretary
..Voter Registration Status Verified ET
ED n a -tr�mn QI Ictin Texts 7R711 -2070 (512) 463 -5800 (TDD 1 -800- 735 -2989)
IC7.dJ CLI IflS I�UII11111JJl Ul l
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APPOINTMENT OF A CAMPAIGN TREASURER
FORM CTA
BY A CANDIDATE
PG �
1 Total pages filed;
See CTA Instruction Guide for detailed instructions.
„I
2 CANDIDATE
MSI MRS IMR FIRST MI
OFFICE USE ONLY
NAME
A����Pa�yla �: i.
Acct #
NICI"E 'LAST SUFFIX
Date Recelved
�.� 6 f�j►r'
r�
3 CANDIDATE
ADDRESS I Po BOX; APT I SUITE t, CITY; STATE; ZIP CODE
MAILING
}
�Ct�C� CtII��MSCAVt�I
ADDRESS
-
,Ddl CA1 Z, `lg�
4 CANDIDATE
AREA CODE PHONE NUMBER EXTENSION
Date Handdellve2dorPostrnarked
PHONE
Date Processed
l U \ 3q % J
Date Imaged
5 OFFICE
HELD
(if any)
6 OFFICE
SOUGHT
_ I /Y
@ C � Z C T t� itl- 1
(if knDWn)
.tot)
7 CAMPAIGN
MSIMRS/MR FIRST MI NICKNAME
LAST SUFFIX
TREASURER
NAMEY1
_
uL�. T.t Sei
8 CAMPAIGN
STREET ADDRESS (NO PO BOX PLEASE); APT ISUnf,, CITY; STATE;
ZIP CODE
TREASURER(
t tCLN��9 `�V�GIVI�
STREET
ADDRESSWI�
`
Z/ �' �(•�
(residence or business)
9 CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
C`��U 3C( 3 0
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.
l am aware of the restrictions in title 15 of the Election Code on contributions
from corporations and labor organizations.
J
Signature fCandidate
Date Signed
GO TO PAGE 2
www.ethics.state.tx.us Revised 07/14/2010
m n aw 12070 Ai isfin Texas 78711-2070 (512) 463 -5800 (TDD 1 -800- 735 -2989)
CODE F FAIR I
FORM CFCP
COVER SHEET
C'C
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 maybe filed with the proper filing
r
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 HanddellveedorPoshnalced
1997, may subscribe to the code at any time.
Date Processed
Subscription to the Code offair Campaign Practices is voluntary.
Date Imaged
1 ACCOUNT NUMBER
2 TYPE OF FILER
(Ethics Commission Flem)
V CANDIDATE POLITICAL COMMITTEE
If tifing as a candidate, complete boxes 3 - 6, If filing for a pofftical committee, comp /ete
Men 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
(PLEASETYPEORPRINT)
An je.11 )go-
/
c
NICKNAME LAST
SUFFIX (SR., JR., III, eta)
6 or
4 TELEPHONE NUMBER
AREA CODE PHONE NUMBER
EXTENSION
OF CANDIDATE
(PLEASETYPEORPRIN1)
5 ADDRESS OF CANDIDATE
STREET/POBOX; APT/SUFTE#, Crn°
STATE ZJP CODE
(PLEASETYPEOR PRINT)
6 OFFICE SOUGHT
BY CANDIDATE
(PLEASE TYPE OR PRINT)
7 NAME OF COMMITTEE
(PLEASETYPE OR PRINT)
8 NAME OF CAMPAIGN
TAE (Dr., Mc, Ms_, eta) FIRST
MI
TREASURER
/4)qo— Ii✓1
I-T. T;
(PLEASE TYPE OR PRINT)
. . . . . . . . . . . . . . . . , . . . , . . .
NICIWAME
. . . . . . . . . . . . . .
SUFFIX(SR-, JR-, III, eta)
] /yLAST
GO TO PAGE 2
www.ethics.state.tx.us Revised 11/23/2010
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711 -2070 (512) 463 -5800 (TDD 1 -BDO-
CODE OF FAIR CA RAIGN PRACTICES
There are basic principles of decency, honesty, aadfairplaythat every candidate andpolitical committee iatbis state
has amoral obligationto observe anduphold, inorderthat, after vigorously contestedbut fairly conducted campaigns,
our citizens may exercisetheir constitutionalrights to afree anduntrammeled choice andthe will ofthe people maybe
My and clearly expressed onthe issues.
0100IM9911639
(1) I will conductthe campaign openly and publicly and limit attacks on my opponeatto legitimate challenges to my
opponent's record and stated positions on issues.
(2) I willnotuse orpermitthe use of character defamation, whispering campaigns, libel, slander, or scumlous 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 notuse campaign material of any sortthatmisrepresents, 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 iategrity or patriotism of my opponent
(5) I will not undertake or condone any dishonest or unethical practice thatten ds to corrupt or und( -,=e 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 atintimidatingvoters or discouuragingthemfrom 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.
() I will immediately and publicly repudiate methods and tactics that may come from others that I have pledgednot
to use or condone. I shalltake 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, herebyvolunt olyendorse, subscribe to, and solemnlypledge myselfto conductthe campaign in accordance
with the above principles and practices.
Signature
Date
www.ethics,state.tx.us Revised 11/23/2010