Michael Dahle2 -22
Prescribed by Secretary of State
Section 141.031, Chapters 143 and 144, Texas Election Code
1/2017
ALL INFORMATION IS fg&IRIEDTO BE PROVIDED UNLESS INDICATED OPTIONAL
APPLICATION FOR A PLACE ON THE !y OYEA Bt!R g I a,0 (!J SPECIAL ELECTION BALLOT
TO: City Secretary/Secretary of Board
1 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) I PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT'
ryl I I r. O AALIF _ d _ M 1 (- A� L 04 HZC
PERMANENT RESIDENCE ADDRESS (Do not include a P.O. Box or Rural
Route. If you do not have a residence address, describe the address
at which you receive personal mail and location of residence.)
.1) -a, C) L r-M 15i1% /V
CITY
-Is e- A &Rlz
PUBLIC EMAIL ADDRESS (If available)
si�tr►w!c..+�-se;a�e
TELEPHONE CONTACT
Home:
Work:
MAILING ADDRESS (Campaign mailing address, if available.)
STATE i ZIP I CITY
STATE I ZIP
°7�it?` . ' -5 e- � C- kTZ I "C -?-a 15 it
OCCUPATION (Do not leave blank) DATE OF BIRTH VOTER REGISTRATION VOID
/ NUMBER (Optional)2
� 5 i 3 6 5i��+
(Optional) LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN
IN STATE IN TERRITORY FROM WHICH THE
OFFICE SOUGHT IS ELECTED3
year (s) L6—year (s)
Cell: a.��-6��(���7°Z
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) X11 Z'1Ae L who being by me
here and now duly sworn, upon oath says.
"I, (name) MI lbirl 0.4AlI –E _ __.,__ of vrk_ _ _ County, Texas, being a
candidate for the office of S ' 1 Z D LAZ 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.
I further swear that the foregoing statements included in my application are in all things tr and rect!,
_
*NATURE ,O
�S—worn to and subscribed before meat , `� this the da of i
�..: Y F�SUI10F ,
Signature of Officer Administering Oath° Tit a of Offic r Administering Oath _
TO BE COMPLETED BY CITY 5ECRETARY OR SECRE RY F B N �
Date Received Sigma f Secretary
i
Voter Registration Status Verified E� - — - __
APPOINTMENT OF A CAMPAIGN TREASURER
BY A CANDIDATE
See CTA Instruction Guide for detailed instructions.
2 CANDIDATE 69SIW5 MtJ- - FIRST nil
NAME
NICKNAME. LAST SUFFIX
�At4Ze,
3 CANDIDATE ADDRESS /PO BOX APTJSUITE# CITY; STATE: ZIP CODE
MAILING
ADDRESS P o, Bay w36 se-hf 2 -, %
4 CANDIDATE
PHONE
5 OFFICE
HELD
(if any)
6 OFFICE
SOUGHT
(if known)
7 CAMPAIGN
TREASURER
NAME
8 CAMPAIGN
TREASURER
STREET
ADDRESS
(residence or business)
9 CAMPAIGN
TREASURER
PHONE
10 CANDIDATE
SIGNATURE
AREA CODE PHONE NUMBER EXTENSION
(-zo 0 b 6 q
AJ IA
ScN��T'2 CITY (OvNC -) L- P L„A4.E 1,f
FORM CTA
PG
....... ...
_ _ .....__............_.
1 Total pages filed:
OFFICE USE ONLY
Filer 11) 0
Date Recaivpd
Date Hand - delivered or Postmarked
Receipt# Amount$
Date Processed
Date imaged —
MSttNR4�h FIRST MI NICKNAME LAST
^A I L-� Ate- 4 1) A /-E
STREET ADDRESS (NO PO BOX PLEASE); APT 1 SUITE !f; CITY; STATE: ZIP CODE
1111aL= -Ft.\151$R>
AREA CODE PHONE NUMBER
(,10) �G9` - $-.-7:)-
seHtR 'T2 t'a<
EXTENSION
SUFFIX
I am aware of the Nepotism Law, Chapter 573 of the Texas Government Code.
1 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 corporatio a o ,, labororga Izatlons.
Signature of Candidate Date Signed
I
I GO TO PAGE 2
`Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 12/7/2017
1
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711 -2070 (512) 463 -5800 (TDD 1- 800 - 735 -2989)
CODE OF FAIR CA LPA1GN
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
12
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,
Date Hand - delivered or Postmarked
1997, may subscribe. to the code at any time.
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 EJ 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( Mr., s., eta) FIRST
MI
(PLEASE TYPE OR PRINT)
M1 - 1�lA�L.......
„5
4)
NICKNAME LAST
SUFFIX (SR., JR., III, etc.)
az E
4 TELEPHONE NUMBER
AREA CODE PHONE NUMBER
EXTENSION
OF CANDIDATE
(PLEASE TYPE OR PRINT)
y� q
V 6 6 �7
! VVV
S ADDRESS OF CANDIDATE
STREET /PO BOX; APTISUITE #, CITY;
STATE; ZIP CODE
(PLEASE TYPE OR PRINT)
IV �E/:ri -z -7 gjsg
6 OFFICE SOUGHT
BY CANDIDATE
(PLEASE TYPE OR PRINT)
7 NAME OF COMMITTEE
(PLEASE TYPE OR PRINT)
8 NAME OF CAMPAIGN TITLE (Dr., Mr., s., eta) FIRST
MI
TREASURER
� � A C2
(PLEASE TYPE OR PRINT) . ..
NICKNAME LAS/T�
SUFFIX (SR., JR.. III, eta)
y %
GO TO PAGE 2
www.ethics.state.tx.us Revised 11/23/2010
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711 -2070
463 -5800 (TDD 1 -80
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 ofthe 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.
,j
/Z�
Signature
9(/D-
Date
www.ethics.stateAx.us Revised 11/23/2010