Daryl John - Place 3AW2 -15, 7/2011
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.
i l F77, ,t
APPLICATION FOR A PLACE ON THE CITY OF 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
t�e�
FULL 0 UNEXPIRED
FULL NAME (17irst, Middle, Last)
PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT
bAr i WA-,ltee- 10"
®tiJ
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.)
2 913 C G, —ScH „ti
CITY
STATE
ZIP
CITY
STATE
ZIP
5C 61-4
Te y_A j
7w, TL(
EMAIL ADDRESS (Optional)
OCCUPATION (Do not leave blank)
DATE OF BIRTH
VOTER REGISTRATION VUID NUMBER
(if applicable)
13
TELEPHONE NUMBER (Include area code) (Optional)
Length of Continuous Residence as of Date Application Sworn
OFFICE: 2-1 o lr� �� u (
IN STATE IN CITY IN DISTRICT OR PRECINCT'
yr(S) � yr(s) yr(S)
HOME:
d lvv 3 eo- y
_8
/ MOS It 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) DAC who being by me
here and now duly sworn, upon oath says: "I, (name) � A � , 7��,.. , of �� . e c• „
County, Texas, being a candidate for the office of �,,�_ t k4t: 3 swear 1hat 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 and correct.”
SIGNATUM OF IDATE
1
Sworn to and subscribed efore me a k V this the day of
ENNIS
NOT LIC
`; STATE OF TEXAS
wadL )
My Commission Expires 11 -03 -18
Signature of Officer administering oath2 Title of Offi er administering o th
TO BE COMPLETED BY CITY SECRETARY:T
�,_J_ 4t,
(See Section 1.007) -DJ j _ 1
Date Received Signature of City Secretary
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711 -2070 (512) 463 -5800 (1 DD 1- 8UU- /3b -2JbU)
APPOINTMENT I GN TREASURER FORM CTA
BY A CANDIDATE PG 1
4 CANDIDATE
1 Total pages filed:
See CTA Instruction Guide for detailed instructions.
2 CANDIDATE
MS /MRS /MR FIRST MI
OFFICE USE ONLY
NAME
� �.���
Acci. #
NICKNAME LAST SUFFIX
Date Processed
Date Received
(a a to \ �� 1 i
)
3 CANDIDATE
ADDRESS / PO BOX; APT/ SUITE #; CITY; STATE; ZIP CODE
MAILING
�C r -7
C e' 11 y I ,_y
ADDRESS
HELD
r �'�
4 CANDIDATE
AREA CODE
PHONE NUMBER
EXTENSION
Date Hand - delivered or Postmarked
PHONE
Date Processed
(a a to \ �� 1 i
)
5 OFFICE
Date Imaged
HELD
r �'�
`
(if any)
l (a,✓ �= 1
6 OFFICE
SOUGHT
C
( ( 1,.
3
(if known)
�'�
�
7 CAMPAIGN
MS /MRSIMR
MI.
NICKNAME LAST SUFFIX
,gFIIRST
4 "1 fir`
NAME
K11. K�
8 CAMPAIGN STREET ADDRESS (NO PO BOX PLEASE); APT/ SUITE #, CITY; STATE; ZIP CODE
TREASURER _ I Z yQ �e,r• e5 1 W /. �-e�^5 .4tc�o,j It.J �1C % �:oIGs
STREET l
ADDRESS
(residence or business)
9 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE /
I10 CANDIDATE
SIGNATURE I am aware of the Nepotism Law, Chapter 573 of the Texas Government Code.
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.
Signa ure of Can to Date Signed
GO TO PAGE 2
www.ethics.state.tx.us Revised 07/14/2010
on Cl v1Or)7n Ai fin Taxac 78711 -9(17n (512) 463 -5800 (TDD1- 800 - 735 -2989)
CODE OF FAIR CAMPAIGN
FORM CFCP
COVER SHEET
CTICES
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
iv ,
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
7 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 (Dr., Mr., Ms., etc.) FIRST
MI
(PLEASE TYPE OR PRINT)
AA f
NICKNAME LAST --°
SUFFIX(SR.,JR.,Ill,etc.)
4 TELEPHONE NUMBER
AREA CODE PHONE NUMBER
EXTENSION
OF CANDIDATE
(PLEASE TYPE OR PRINT)
5 ADDRESS OF CANDIDATE
STREET IPOBOX; APT /SUrTE #, CITY;
STATE; ZIP CODE
(PLEASE TYPE OR PRINT)
„
6 OFFICE SOUGHT
BY CANDIDATE
f... y
(PLEASETYPEORPRINT)
�'f- - "✓"-� .. 6 ,1 ,3
JJ:
7 NAME OF COMMITTEE
(PLEASE TYPE OR PRINT)
$ NAME OF CAMPAIGN
TITLE (Dr., Mr., Ms., etc.) FIRST
MI
TREASURER
h4 ^ f
(PLEASE TYPE OR PRINT)
........ ....... .............................
NICKNAME LAST//
SUFFIX(SR., JR., III, etc.)
g
GO TO PAGE 2
www.ethIcs.state,tX.us Revised 11/23/2010
Texas tinicsuommission KU. bOX I ZUIU Austin, Texas Ib[ I"I -ZULU (b"IZ)4b�J-bbUU
There are basic principles of decency, honesty, andfairplaythat every candidate andpolitical committee inthis state
has amoral obligationto observe anduphold, in order that, aftervigorously contestedbut fairly conducted campaigns,
our citizens may exercise their constitutional rights to a free and untrammeled choice andthe will ofthe people maybe
fully and clearly expressed on the issues.
THEREFORE:
(1) I will conduct the campaign openly andpublicly 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, norwill I
use malicious or unfounded accusations that aim at creating or exploiting doubts, without justification, as to the
personal integrity or patriotism ofmy opponent.
(5) I will notundertake or condone any dishonest orunethical 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 upholdthe 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, herebyvoluntarily endorse, subscribe to, and solemnlypledge myselfto conduct the campaign in accordance
with the above principles and practices.
Signature Date
www,eth1cs. state. tx.us Revised 11123/2010