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Jeremy Wells-21 arescri bed by Secretary of State section 141.031. chapters 143 and 144, Texas Election Code 5/2017 ALL INFORMATION IS REQUIRED TO BE PROVIDED UNLESS INDICATED OPTIONAL APPLICATION FOR A PLACE ON THE 70 11 Cif of ScAe&z 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 P/� CCU 91 FULL r ❑ UNEXPIRED FULL NAME (First, Middle, Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE :S'e yes,, y IV�/�) Is l Nremy We-11s PERMANENT RESIDENCE ADDRESS (Do not include a P.O. Box or Rural i PUBLIC MAILING ADDRESS Route. If you do not have a residence address, describe the address at which you receive personal mail and location of residence.) INC 16v;nroi%1-t— 6feeJk CITY SGl;, eri z PUBLIC EMAIL ADDRESS (If available) ke,IfsSeremy 016rA ;"C-or, STATE ZIP CITY TX 78151( OCCUPATION (Do not leave blank) DATE OF BIRTH k-EIV S 1e SHpervjso>r 0 7 10611111 TELEPHONE CONTACT INFORMATION (Optional) Home: Work: 210 'O t ,5 t7 l f Cell: mailing address, if available.) STATE f I zip VOTER REGISTRATION VUID NUMBER (Optional }z LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORIf IN STATE %Z 3 year (s) month(s) IN TERRITORY FROM WHICH THE OFFICE SOUGHT IS ELECTED year (s) 3 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) J -Mrem y V v e' 1L5 who being by me here and now duly sworn, upon oath says: / "I, (name) Se�rem y ��IIs of t t4c." Ol)IIt County, Texas, being a candidate for the office of Li }l 6014ricEL swear that 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. I further swear that the foregoing statements included in my application are in all things true and correct." X SIGNATURE`-(* Sworn to and subscribed before me at this the Signature of Officer Administering Oath Title of TO BE COMPLETED BY CITY SECRETARY OR SECRETARY QF B RD: (See Section 1.007) — Date Received Voter Reeistration Status Verified Admin Signature of Secretary 3milal PUBLIC - S'QIiE OF MIAS ID f 1312M l4 APPOINTMENT OF A CAMPAIGN TREASURER FORM CTA BY A CANDIDATE PG 1 1 i — - ' See CTA Instruction Guidefordetailed instructions. 1 Total pages filed: 1 2 CANDIDATE MS /MRS /MR FIRST Ml OFFICE USE ONLY NAME -5 of a FA Filer ID # NICKNAME LAST SUFFIX Date Received spy Wills 3 CANDIDATE ADDRESS / PO BOX; APT I SUITE #, CITY; STATE; ZIP CODE MAILING ADDRESS ADDRESS 6 �W;nn CrtCj< s��rrr fL� rX X815 I l Date Hand - delivered or Postmarked 4 CANDIDATE AREA CODE PHONE NUMBER EXTENSION Receipt# Amount$ PHONE 3 ef yv /f � ,f Date Processed 6 OFFICE ! Date Imaged HELD (if any) 6 OFFICE SOUGHT % lj �' GCS. (if known) 7 CAMPAIGN MSIMRSIMR FIRST MI NICKNAME LAST SUFFIX TREASURER NAME I 0 a CAMPAIGN STREET ADDRESS (NO PO BOX PLEASE); APT I SUITE #; CITY; STATE; ZIP CODE TREASURER f1 STREET �1Jiy1 � n + Grrek s��cr�� Tx � �i) ;11 ADDRESS i 7 f (residence or business) I � 9 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION TREASURER 'PHONE 1 j� (Vu } C 3 1 C� / v" t0 'CANDIDATE I 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 15of the Election Code. i am aware of the res5 ' iife 1-5 of the Election Code on contributions from corporati d labor organizations. lgnature 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 Campaign Practices. The Code may be filed with the proper filing _4 5 _1 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 ® 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 ML, Ms,,etc.) FIRST MI (PLEASETYPEORPRINT) I(Dr., A. -,Se ee 7 L rerr'y W� I�� NICKNAME LAST SUFFIX (SR., JR., III, etc.) 4 TELEPHONE NUMBER AREA CODE PHONE NUMBER EXTENSION OF CANDIDATE {!2 `20 0 (PLEASE TYPE OR PRINT) 5 ADDRESS OF CANDIDATE /PO BOX; APT / SUITE #, CITY; STATE ZIP CODE (PLEASETYPEORPRINT) 11ttSTREET y�� '� Ck Schertz %X :? tIs j 6 OFFICE SOUGHT BY CANDIDATE j. it (PLEASE TYPE OR PRINT) C I ! Covil r- ��@ j NAME OF COMMITTEE (PLEASE TYPE OR PRINT) $ NAME OF CAMPAIGN TREASURER TITLE (Dr., Mr., Ms., etc-) FIRST Al MI L, r own y (PLEASETYPEORPRINT) . . . . . . . . . . . . . . . . . . - - NICKNAME LAST SUFFIX (SR., JR., III, etc.) GO TO PAGE 2 www.ethics_state.tx.us Revised 11/23/2010 IGA=� CU UW VUU II IIIIWUII M. %J OUX ILUIU 1AUSTII7, lexas fol- 11-LU /U (0l,&)403 -00UU (IUU "1 -tfUU- 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 anduphold, in orderthat, aftervigorously contested butfairly conducted campaigns, our citizens may exercise their constitutional rights to a free and untrammeled choice and the will ofthe people may be fully and clearly expressed on the issues. 11.1 a: (1) Iwill 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 or pen-nit 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 orpattiotism ofmy 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) 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 conductthe campaign in accordance with the above principles and practices. Date www.ethics.state.tx.us Revised 11/23/2010