Ralph Gutierrez2 -21
Prescribed by Secretary of State
Section 141.031, Chapters 143 and 144, Texas Election Code
1/2017
ALL INFORMATION IS REQUIRED TO BE PROVIDED UNLESS INDICATED OPTIONAL
APPLICATION FOR A PLACE ON THE G GJ' f Z 7-X GENERAL 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.) FATE TERM
FULL
IyR I,IOIr ❑UNEXPIRED
FULL NAME (First, Middle, Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOTI
hie l/ ee oe Z Atlo. 6:ul/IClyez
PERMA ENT RESIDENCE ADDRESS (Do not include a P.O. Box or Rural PUBLIC AILING 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.) 1014 S,Avee /,oee 9XV
10A6 S. /ve1, free ,8l al
CITY STATE I ZIP CITY STATE ZIP
Sr,Xeo X X 17 0 I3y '5 z 7x I -7 S /S�
PUBLIC EMAIL ADDRESS (If available) OCCUPATION (Do not leave blank) DATE OF BIRTH VOTER REGISTRATION VUID
NUMBER (Optional)'
a 7Z ISZ .2 ��ay r��c
Aekeewl 02 / /2 //f"Sel
T LEPHONE CONTACT INFORMATION (Optional) LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN
Home: IN STATE IN TERRITORY FROM WHICH THE
OFFICE SOUGHT IS ELECTED
Work:
7 year (s)
27 year (s)
Cell: q/O U _L 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. f%
Before me, the undersigned authority, on this day personally appeared (name) itt&,,, C1 1•exled? . _ . who being by me
here and now duly sworn, upon oath says:
"I, (name) / /! al ,*I ez of 6Kwa 6 _ County, Texas, being a
candidate for the o ice of IV Ci-f , swear that rwill support and defend the Constitution and laws
of the United States and of the Sta a 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.
I further swear that the foregoing statements included in my application are in all th �sLtruu d correct."
GNATURE OF CAN
Sworn to and subscribed before me at this the _ v of , L _ , I __):j%
M
Signature of Officer Administering Oath" Tide of
TO BE COMPLETED BY CITY SECRETARY OR SECR ARY QF BOARD:
(See Section 1.007) _�
Date Recelve
Voter Registration Status Verified ❑
r Administering Oath
Signature of Secretary
BRE>rlllk LOWE DEWS
MRARY KWC - STATE OF TI
W f 131740/4
L9 bpbm l?
APPOINTMENT OF A CAMPAIGN TREASURER FORM CTA
BY A CANDIDATE PG 1
*
See CTA Instruction Guide for detailed instructions. 1 Total pages filed: r
I
2 CANDIDATE
MS /MRS /MR FIRST MI
OFFICE USE ONLY
NAME
n
Filer ID #
NICKNAME IR` LAST SUFFIX
/ //�� o /�•} %� y/��
Dale Received
3 CANDIDATE
ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE
J
MAILING
ADDRESS
%C `yI
S��e��2 7645 `
Date Hand - delivered or Postmarked
Receipt# Amount$
4 CANDIDATE
AREA CODE PHONE NUMBER EXTENSION
PHONE
NI
V( � 1V g 7g I � iy f �/
` (/ (',(' (,Y CyJ[!/ Vx
Date Processed
Date Imaged
5 OFFICE
HELD
/
•T
(if any)
`f u� e �/ VL
6 OFFICE
SOUGHT
(if known)
7 CAMPAIGN
MS/MRS/M FIRST MI NICKNAME LAST SUFFIX
TREASURER
NAME
AM e A / eZ
8 CAMPAIGN
STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE; ZIP CODE
TREASURER
STREET
ADDRESS
(residence or business)
9 CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
ylos,
s /.Z- 77�o
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.
l
I am aware of the restrictions in title 15 of the Election Code on contributions
from corporations and labor organizations.
/ 7 i�f
Agneiture
of Candidate Date Signed
GO TO PAGE 2
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 12/7/2017
Texas Ethics Commission P.O. Box 12070 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
a4jl
Campaign Practices. The Code may be filed with the proper filing
7
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,
1997, may subscribe to the code at any time.
Date Hand-delivered or Postmarked
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 Rf 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.)
AREA CODE PHONE NUMBER EXTENSION
4 TELEPHONE NUMBER
OF CANDIDATE
(PLEASE TYPE OR PRINT)
/ 1 }�
j (/)
-
`J O V V
5 ADDRESS OF CANDIDATE
STREET/ PO BOX; A(PTT /SUITE #; CITY; STATE; ZIPCODE
(PLEASE TYPE OR PRINT)
f�
//
�S•lvetlree 8/v/ Sch e --l2 7X
6 OFFICE SOUGHT
BY CANDIDATE
(PLEASE TYPE OR PRINT)
o
7 NAME OF COMMITTEE
(PLEASE TYPE OR PRINT)
8 NAME OF CAMPAIGN
TITLE (Dr., Mr., Ms., etc.) FIRST MI
TREASURER
(PLEASE TYPE OR PRINT)
. . . . . Ali . . .
NICKNAME LAST SUFFIX (SR., JR., III, etc.)
AtW�I AA e
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
CODE OF FAIR CAMPAIGN PRACTICES
(TDD 1 -800-
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 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) Twill 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 corrupt or 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) 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 conduct the campaign in accordance
with the above principles and practices.
a
Signature
www.ethics.state.tx.us
Date
Revised 11/23/2010