Dan Swart2-49
Prescribed by Secretary of State
Section 141.031, Chapters 143 and 144, Texas Election Code; Section 11.055, Texas Education Code
07/2025
APPLICATION FOR A PLACE ON THE BALLOT FOR A GENERAL ELECTION
FOR A CITY, SCHOOL DISTRICT OR OTHER POLITICAL SUBDIVISION
ALL INFORMATION IS REQUIRED TO BE PROVIDED UNLESS INDICATED AS OPTIONAL' Failure to provider quired information may result in re'ection of appl
APPLICATION FOR A PLACE ON THE G/r �F 5�-:'?c=�T xt L ELECTION BALLOT
TO: City Secretary/Secretary of Board (name of election) SPEC f,4
I request that my name be placed on the above -named official ballot as a candidate for the office indicated below.
OFFICE SOUGHT
ude any place�% ber or other distinguishing number, if any.) INDICATE TERM
`� �7- 4— / %G2 FULL NJ�UNEXPIRED
FULL NAME (First, Middle, Last)
PERMANENT RESIDENCE ADDRESS (Do not include a P.O. Box or Rural Route. If
you do not have a residence ddress, describe to ation of residence.)
lrJc�
CITY STATE ZIP
!jda( rx
PUBLIC EMAIL ADDRESS (Optional) (Address for OCCUPATION (Don leas
which you receive campaign related emails, if available.) O li _ / , L4
TELEPHONE CONTACT INFORMATION (Optional)
Home.• _ Office:
FELONY CONVICTION STATUS (You MUST check one)
have not been finally convicted of a felony.
❑ 1 have been finally convicted of a felony, but 1 have been
pardoned or otherwise released from the resulting
disabilities of that felony conviction and I have provided
proof of this fact with the submission of this application.3
PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT*
PUBLIC MAILING ADDRESS (Optional) (Address for which you receive
campaign related correspondence, if available.)
CITY
STATE I ZIP
blank) DATE OF BIRTH VOTER REGISTRATION VUID
5
NUZ (Optional)
o�� /�� Z 17,V143 19
Cell:
LENGTH OF CONTINUOUS RESIDENCE AS OF DATE THIS APPLICATION WAS
IN THE STATE OF TEXAS IN TERRITORY/DISTRICT/PRECINCT FROM
WHICH THE OFFICE SOUGHT IS ELECTED
year(s) year(s)
month(s) �_ month(s)
This Box Must ONLY be Completed by Candidates for School District Board of Trustees
Check the Box Below:
1 am aware that I am not eligible to serve as a trustee of an independent school district if I am required to register as a sex offender under Chapter 62, Code
of Criminal Procedure.
'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
nckname does not constitute a slogan or contain a title, nor does it indicate a political, economic, social, or religious view or affiliation. 1 have been commonly
cnown by this nickname for at least three years prior to this election. Please review sections 52.031, 52.032 and 52.033 of the Texas Election Code regarding the
•ules for how names may be listed on the official ballot.
"Before me, the undersigned authority, on this day personally appeared (name of candidate)_ ]LLJr 1: , who being by me here
land now duly sworn, upor) opth�ays:
"I, (name of candidate) w� �/e ,+�c s' c,l r+ of 4 -fi�D P _ County, Texas, Being a candidate fc
!the office of _�; �CC�1,_t ; P/� c[ . swear that I will support and de nd the Constitution and laws of the United States and of the
State of Texas. lam s citizen of the United States eligible to hold such office under the constitution and laws of this state. 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 c
the nepotism law, Chapter 573, Government Code. I am aware that I must disclose any prior felony conviction, and if so convicted, must provide proof that I hav
been pardoned or otherwise released from the resulting disabilities of any such final felony conviction. I am aware that knowingly providing false information on
the application regarding my possible felony conviction status constitutes a Class misdemeanor. I further sw that the foregoing statements in my
application are in all things true and correct.+�"0 '00l
Sworn to and subscribed beforg me is the day of'J 10 heir —by by _§�1 LJI l
/n [ (day) (month) (yearly. '.4aw9e of
Administer Oath° of Officer Authorized to Administer Oath
U aa• SHEILA M EDMONDSON
_° `� Notary lD #124952131�i_ ai { li;r ,,;; s`;
My Commission Expires
Title of Officer thorized to Administ th "'r„ chA2?n�
TO BE COMPLETED BY FILING OFFICER: THIS APPLIrQ
lF 'RED FILING FEE (If Applicable) PAID BY:
CASH ❑ CHECK MONEY ORDER CASHIERS CHECK OR — PETITION IN LIEU OF A FILING FEE.
This document and $ filing fee or a nominating petition of pages receAedA N:�oteyl ¢gistration Status Verified
11 / 6 rl / P5' V /0�rJ L (See Section 1.007)
Date Received Date Accepted
or
APPOINTMENT OF A CAMPAIGN TREASURER
BY A CANDIDATE
See CTA Instruction Guide for detailed instructions.
2 CANDIDATE MSIMR ± FIRST MI
NAME A ,- // am DI
NICKNAME L5L4JIV�7—
ASST SUFFIX
Da, r L
3 CANDIDATE ADDRESS / PO BOX; A..PT I SUITE #; CITY; STATE; ZIP CODE
MAILING % /Q y �Gt�L��`GUa/ ,� IQ/ ,
ADDRESS 7 % /l Lf/0
FORM CTA
PG 'I
1 Total pages filed:
OFFICE USE ONLY
Filer to #
Dat ever
��.0
y
Date Hand delivered or Postmarked
4 CANDIDATE
AREA CODE PHONE NUMBER
EXTENSION
Receipt#
Amount$
PHONE
2—
Date Processed
5 OFFICE
HELD
Date Imaged
(if any)
6 OFFICE
SOUGHT
(if known)
� � w
�' / Plea
p /� � (
7 CAMPAIGN
MSlMRS FIRST MI
NICKNAME
LAST SUFFIX
TREASURER
NAME
f /1 2)
b a, n
(mil/J o
Cl wl
8 CAMPAIGN
TREASURER
STREET
ADDRESS
(residence or business)
STREET ADDRESS; APT / SUITE #; CITY; STATE; ZIP CODE
9 CAMPAIGN
AREA CODE
PHONE NUMBER EXTENSION
TREASURER
PHONE
/ �/
2—
— /0 XD
10 CANDIDATE 1
SIGNATURE 1 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 and labor organizations.
Signature of Candidate Date Signed
GO TOPAGE 2
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 1/1/2025
CANDIDATE MODIFIED
REPORTING DECLARATION
11 CANDIDATE
NAME
4kh
12 MODREPORTINIFIED G COMPLETE THIS SECTION ONLY IF YOU ARE
DECLARATION I 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 $1,110 in political contributions or
make more than $1,110 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.
Year of election(s) or election cycle to
which declaration applies
Signature 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 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/fiilinginfo/QuickFileAReport.php
Forms provided by Texas Ethics Commission www.ethics.state.tx.us
Revised 1/1/2025
CODE OF FAIR CAMPAIGN
PRACTICES
FORM CFCP
COVER SHEET
OFFICE USE ONLY
Pursuant to chapter 258 of the Election Code, every, candidate and DateReceived —
political committee is encouraged to subscribe to the Code of Fair
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
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 TXl POLITICAL COMMITTEE
If filing as a candidate, `complete boxes 3 - 6, tf 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., W., Ms., etc.)
FIRST
MI
(PLEASE TYPE OR PRINT)
/
4b
---------------------------------------------------------------------------
NICKNAME
L,AS`T�
SUFFIX (SR., JR., Ill,etc.)
`t I/1-
Ste✓
4 TELEPHONE NUMBER
AREA CODE
PHONE NUMBER
EXTENSION
OF CANDIDATE
(PLEASE TYPE OR PRINT)
�!/ ^ �
5 ADDRESS OF CANDIDATE
TYPE OR PRINT),X
STREET/POB/O7X ;A)PTISUTECITY;
ZIPCODFr(PLEASE
6 OFFICE SOUGHT
BY CANDIDATE
S� �7—
f Ge ✓iG� l
P�QCG
(PLEASE TYPE OR PRINT)
7 NAME OF COMMITTEE wf
I
(PLEASE TYPE OR PRINT)
8 NAME OF CAMPAIGN
TITLE (Dr., Mr., Ms., etc.)
FIRST
MI
TREASURER
(PLEASE TYPE OR PRINT)
---------------------------------------------------------------------------
+
NICKNAME
LAST
SUFFIX (SR., JR., III, etc.)
GO TO PAGE 2
Forms provided by Texas Ethics Commission
www.ethics.state.tx.us
Revised 1/1/2021
CODE OF FAIR CAMPAIGN PRACTICES
There are basic principles of decency, honesty, and fairplay that every candidate and political committee in this state
has amoral obligation to observe and uphold, in orderthat, aftervigorously contested but fairly conducted campaigns,
our citizens may exercise their constitutional rights to a flee and untrammeled choice and the will ofthe people may be
fully and clearly expressed on the issues.
10 IN 21 Wei
(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 orpermit 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 ofany 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 orpatriotism ofmy 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.
() 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 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 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
i
Date
Forms provided by Texas Ethics Commission wwmethics.state.tx.us Revised 1/1/2021