Kristopher Evans2 -21
Prescribed by Secretary of State
Section 141.031, Chapters 143 and 144, Texas Election - Code,
i/2017
ALL INFORMATION IS REQUIRED TO BE PROVIDED UNLESS INDICATED OPTIONAL _
APPLICATION FOR A PLACE ON THE 1t1v ✓trn )1•eC � ;LO 14) 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.) INDICATE TERM
IX
GI )- C u ❑UNEXPIRED
FULL NAME ( (rst, Middle, Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT"
)� C-; 5 �c 'Ae (- A � � ) t61 -0 ' he r evm yv 3
PERMMENT ENCE ADDRESS ( • 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
at which you receive personal mail and location of residence.)
31) cq \AAI
CITY
PUBLIC EMAIL ADDRESS (If available)
TELEPHONE CONTACT INFORMATION
STATE ZIP CITY
r)( 1 -7 91o9
OCCUPATION (Do not leave blank) I DATE OF BIRTH
LENGTH OF C NTINUOUS RESIDE
STATE ZIP
VOTER REGISTRATION VUID
NUMBER (Optional) 2
/ ofir l _;
E AS OF DATE APPLICATION SWORN
Home: I IN STATE IN TERRITORY FROM WHICH THE
OFFICE SOUGHT IS ELECTED
Work: 2• year (s) L year (s)
Cell: —� i' _ 14 73 l month(s) months)
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)_ ��`� �, �eCi�lx �s . who being by me
here and now duly sworn, upon oath says:
"I, (name) _ %/5�C`r 5 � XC C I Trim -3 of -r - C- County, Texas, being a
candidate for the office o & - C� 3. j ) swear that rwill 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.
I further swear that the foregoing statements included in my application are in all thipgs t e and correct."
Sworn to and subscribed before me at
3", /'. � % i r
Officer Administering Oath"
this the day of
Titl erof
TO BE CdMPLETED BY CITY SECRETARY OR SECRETARY OF BOARD:
(See Section 1.007) A�
. Date Received
Voter Registration Status Verified
SIGNATURE OF CAN
Oath
......... p(i
(SEA� }�:
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 12/7/2017
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
MSlMRSlMR FIRST MI
OFFICE USE ONLY
NAME
b
Filer 16# _
NICKNAME LAST SUFFIX
Date Received
3 CANDIDATE
ADDRESS /PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE
MAILING
ADDRESS
Date Hand -delivered or Postmarked
Receipt# Amount$
4 CANDIDATE
AREA CODE PH 'NE NUMBER EXTENSION
PHONE
el
v J l
Date Processed
Date Imaged
5 OFFICE
HELD
(if any)
.J v
6
OFFICE
SOUGHT
(if known)
7
CAMPAIGN
MS/MRS /MR FIRST MI NICKNAME
LAST SUFFIX
TREASURER
NAME
8
CAMPAIGN
STREET ADDRESS (NO PO BOX PLEASE); APT l SUITE #, CITY; STATE;
ZIP CODE
TREASURER
STREET
ADDRESS
(residence or business)
� 1 3 (Jf
JEXTENSION
9
CAMPAIGN
AREA CODE PHONE NUMBER
TREASURER
PHONE
04 O) r 53 5 3
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 nd labor organizations.
V131��01
SAfature of Candidate
Date Signed
GO TO PAGE 2
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 12/7/2017
CANDIDATE MODIFIED
REPORTING DECLARATION
11 CANDIDATE
NAME
12 MODIFIED
REPORTING
DECLARATION
COMPLETE THIS SECTION ONLY IF YOU ARE
CHOOSING MODIFIED REPORTING
FORM CTA
PG 2
•• 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.
_�Zp ) `)
Year of election(s) or election cycle to
which declaration applies
SigKature of Candidate
This appointment is effective on the date it is filed with the appropriate filing authority.
TEC Filers may send this form to the TEC electronically at treasappoint@ethics.state.tx.us or
Fax this form to 1512) 463 -8808 or mail to
Texas Ethics Commission
P.O. Box 12070
Austin, TX 78711 -2070
Non -TEC Filers must file this form with the local filing authority
DO NOT SEND TO TEC
For more information about where to file go to:
https: //www.ethics.state.tx. us/ whatsnew /NewFilersGettingStarted. html
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 CAN4PAIGN
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
p,
�� 1
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 file as of September 1,
1997, may subscribe to the code at any time.
Date Hand - delivered or Postmarked
,Subscription to the Code of Fair Campaign Practices is voluntary.
Date Processed
Date Imaged
1 ACCOUNT NUMBER
2 TYPE OF FILER
(Ethics Commission Filers)
CANDIDATE V POLITICAL COMMITTEE Ej
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
(PLEASE TYPE OR PRINT)
TITLE (Dr.,, Mr., Ms., etc.) FIRST
MI
NICKNAME LAST
SUFFIX (SF/JR., III, etc.)
ie;Uool� 3
4 TELEPHONE NUMBER
AREA CODE PHONE NUMBER
EXTENSION
OF CANDIDATE
(PLEASE TYPE OR PRINT)
5 ADDRESS OF CANDIDATE
STREET /PO BOX; APT /SUITEtl; CITY;
STATE; ZIP CODE
(PLEASE TYPE OR PRINT)
3golij 1A -b >,r t3) z,.he,rtz- J-A -Wd .
6 OFFICE SOUGHT
BY CANDIDATE
(PLEASE TYPE OR PRINT)
`
7 NAME OF COMMITTEE
(PLEASE TYPE OR PRINT)
8 NAME OF CAMPAIGN
TREASURER
TITLE (Dr., Mr., Ms., etc.) FIRST
A r C }_ t�;��vp)-,-e�
MI
)
(PLEASE TYPE OR PRINT)
. . . . . . . . . .
NICKNAME LAST
. . . . . .
SUFFIX (SR., JR., III, ela)
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 JDD 1- 800 -735 -2989)
CODE OF FAIR CAMPAIGN PRACTICES
There are basic principles of decency, honesty, and fair play that every candidate and political committee in this state
has amoral obligation to observe and uphold, in orderthat, 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) 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 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 myself to conduct the campaign in accordance
with the above principles and practices.
Signature
09.07 3
Date
www.ethics.state.tx.us Revised 11/23/2010