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Dani Salas - Place 3AW2 -15, 712011 Prescribed by Secretary of State Sections 141.031, 143.004, 143.006, Texas Election Code All information is required to be provided unless indicated as optional. APPLICATION FOR A PLACE ON THE CITY OF D W11 Z GENERAL ELECTION BALLOT TO: City Secretary 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 FULL 0 UNEXPIRED FULL NA First, Middle, Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT 42111,doile Z& ee D &I 1, 54 ids PERMANENT RESIDENCE ADDRESS (Street address and apartment MAILING ADDRESS (If different from residence address) number. If none, describe location of residence. Do not include P.O. Box or Rural Rt.t.)�} 0 tom/ r IF/ A 4-m CITY STATE �x ZIP CITY STATE ZIP 2MA EMAIL ADDRESS (Optional) OCCUPATION (Do not leave blank) DATE OF BIRTH VOTER REGISTRATION VUID NUMBER (if applicable) i��ad 5,445 -0 " krv)t li or qktkl V5 TELEPHONE NUMBS (Include area code) (Optional) Length of Continuous Residence as of Date Application Sworn OFFICE: l D - o6 IN STATE IN CITY IN DISTRICT OR PRECINCT' )p HOME: oc,� (� �� °� %�j� yr(s) yr(s) yr(s) mos mos mos 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) e who being by me here and now duly sworn, upon oath says: "I, (name) of County, Texas, being a candidate for the office of swear tha 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 true an c rec ." X Yawl__ SIGNATURE OF CANDIDATE Sworn to and subscribed before meat(, t , this the ( day of AD BRENDA LDUlSE DENNIS NOTARY PUBLIC .. Signature of Officer administering oath' Title of Officer administering o t STATE OF TEXAS My Commiglon Ealres TO BE COMPLETED BY CITY SECRETARY: (See Section 1.007) c� Date Received Signature. f City Secretary Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711 -2070 (512) 463 -5800 (TDD 1- 800 -735 -2989) APPOINTMENT FORMCTA BY A CANDIDATE PG See CTA Instruction Guide for detailed instructions. 1 Total pages filed: 2 CANDIDATE MS /MRS/MR FIRST MI OFFICE USE ONLY NAME m ( 5 /' �� C 4A Acct. # ...... ............................... NICKNAME LAST SUFFIX Date Received 3 CANDIDATE MAILING ADDRESS ADDRESS /POBOX; APT / SUITE #; CITY; STATE; ZIP CODE ©0 -,�1� 4 CANDIDATE AREA CODE PHONE NUMBER EXTENSION Dale Hand - delivered or Postmarked PHONE �y y GVGD \ r`C '1' - a� 1 /� V If Dale Processed 5 OFFICE HELD f Date Imaged (if any) 6 OFFICE SOUGHT (if known) (1� 7 CAMPAIGN MS /MRS/MR FIRST MI NICKNAME LAST SUFFIX TREASURER NAME DSO Ads 8 CAMPAIGN STREET ADDRESS (NO PO BOX PLEASE); APT/ SUITE #, CITY; STATE; ZIP CODE TREASURER STREET n /� ADDRESS (residence or business) I� CJ 9 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION TREASURER PHONE 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 corp or and labor organizations. �/, 1, - Sign6turd of Candidate Date Signed GO TO PAGE 2 www.ethics.state.tx.us Revised 07/14/2010 C- -r --- 7a71•i_ornn fr,19)4R3 -5800 (TDD 1- 800 - 735 -2989) texas roues uornrims iun r.v. CODE OF FAIR CAINVINPAIGN FORM CFCP COVER SHEET PRACTICES OFFICE USE ONLY Pursuant to chapter 258 of the Election Code, every candidate and Date Received committee is encouraged to subscribe to the Code of Fair political Campaign Practices. The Code may be filed with the proper filing � authori ty u p on 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 orPostmarked 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 Ft ers) 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 (PLEASE TYPE OR PRINT) TITLE (Dr.,Mr.,Ms.,etc.) FIRST � �1 alrb MI NICKNAME LAST SUFFIX (SR., JR., III, eta) 4 TELEPHONE NUMBER AREA CODE PHONE NUMBER EXTENSION OF CANDIDATE (PLEASE TYPE OR PRINT) 5 ADDRESS OF CANDIDATE (PLEASETYPE OR PRINT) STREETJPOBOx; JAPT /surrE# -, CITY; �\ �STATE; ZIP CODE ✓� 6 OFFICE SOUGHT BY CANDIDATE (PLEASE TYPE OR PRINT) 7 NAME OF COMMITTEE (PLEASE TYPE OR PRINT) 8 NAME OF CAMPAIGN TITLE (Dr., Mr., Ms., etc) FIRST TREASURER O �IQLs MI (PLEASE TYPE OR PRINT) --- •- •---- -• -• —• • - -- Cs NICKNAME LAST SUFFlX(SR.,JR.,Ill, eta) GO TO PAGE 2 www.ethics.state.tx.us Kevlseci iliz:3i2viu texas Ethics Gommissfon H.U. Box 120/U Austin, lexas (6(11 -2U(U (b12) 463 -bbUU (I UU 1- bUU- Nb -2ytiy CODE OF FAIR CAMPAIGN PRACTICES There arebasic principles of decency, honesty, andfairplaythat every candidate andpolitical committee irnthis state has amoral obligation to observe and uphold, in order that, after vigorously contestedbut fairly conducted campaigns, our citizens may exercise their constitutional rights to a free anduntrammeled choice andthewill ofthe people maybe 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 statedpositions 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 onrace, 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 orunfounded 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 thathampers orprevents the full and free expression ofthe will ofthe voters, including any activity aimed atintimidatingvoters or discouraging themfromvoting. (6) I will defend andupholdthe 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 andpublicly 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, herebyvoluntarily endorse, subscribe to, and solemnlypledge myselfto conduct the campaign in accordance with the above principles andpractices. &z6-- Signature Yy1/7 -/s Date www.ethlcs.state.tx.us Revised 11/23/2010