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Don E. Taylor - Place 4AW2 -15, 7/2011 Prescribed by Secretary of t Sections 141, 31, 14 004 i [ 43'006, Texas Election Code All information is required to be provided unless indicated as optional. /t APPLICATION FOR A PLACE ON THE CITY OF GENERAL ELECTION BALLOT TO: City Secretary I request that my name lie pllaced i on the above -named official ballot as a candidate for the office indicated below. i OFFICE SOUGHT Includ/e place numbettrl1or other distinguishing number, if any. INDICATE TERM C ( 4- t�D �any u hC i 1 P I � � FULL 0 t:� UNEXPIRED FULL NAME (First; Middle, Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT D�r�a fd L�1!� VITA I,b Dor E. day (or r 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.) Z `f 3( Tree 13 ranG� i CITY SG%ertz STATE ! T1,,cas ZIP CITY STATE ZIP EMAIL ADDRESS (Option ! ) OCCUPATION (Do not leave blank) DATE OF BIRTH VOTER REGISTRATION VUID NUMBER LlD11Bf % ar r /z3 0 ce,,., ��7�'ire (if applicable) ya o. 7 12-f /39 I I ()1 Q,3 a 0 3 TELEPHONE NUMBER (I{ elude area code) (Optional) Length of Continuous Residence as of Date Application Sworn OFFICE: IN STATE IN CITY IN DISTRICT OR PRECINCT' HOME: (2 ! o) Lo 5 q y 3 L} (� yl(s) / Dyr(s) 10 yl•(5) 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 Noes not constitute a slogan nor does it indicate a political, economic, social, or religious view or I have affiliation. been commonly known by this nickname for at least three years prior to this election. i Before me, the undersiginedlauthority , on this day personally a pealed (name) "r- ,p �vho being by me here and now duty sworn, I upon oath says: "I, (name) of County, Texas, being a candidate for the office of 4 i. swear that I will support and defend the Constitution andjlaws of the United States and of the ate of Texas. I am a citizen of the United States eligible to hold such office under the Constitution and lays of this state. I have not been tonally convicted of a felony for which I have not been had full pardoned or my rights of citizenship restored .by othe�• official action. I have not been determined by a final judgment of a court exercising probate jurisdiction to be totally mentally incapacitated or pakially mentally incapacitated without the right to vote. I am aware of the nepotism taw, Chapter 573, Government Code. i I further swear that the foregoing statements included in my application are in all things true and correct." F G I' SIGNATURE OF CANDIDATE Sworn to and subscribed before me at , `{ this the _ day of `lt. / BRENDA LOUISE DENNIS d. NOTARY PUBLIC Signature of Officer adtrrinistering oath' Title of Officer administering oa STATE OF TEXAS my Cor MMIon Expires 11.0318 TO BE COMPLETED BY CITY SECRETARY: - I � (See Section 1.007) Date Itecely d Signature of City Secretary i I, Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711 -2070 (512) 463 -5800 (TDD 1 -800 -/ There are basic principles of decency, honesty, andfairplay that every candidate andpolitical committee inthis state has amoral obligation to observe and uphold, in order that, after vigorously contested but fairly conducted campaigns, our citizens may exercise their constitutional rights to a free anduntrammeled 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, 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 notundertake 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 many 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 goveming 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 solemnlypledgemyselfto con-duct the campaign inaccordance with the aboveprinciples andpractices. S' tore 7 l—�— Date www,ethics. state. tx.us Revised 11123/2010