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.
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APPLICATION FOR
A PLACE ON THE CITY OF GENERAL ELECTION BALLOT
TO: City Secretary
I request that my name lie pllaced
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on the above -named official ballot as a candidate for the office indicated below.
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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
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VITA I,b
Dor E. day (or
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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.)
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CITY
SG%ertz
STATE
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ZIP
CITY
STATE
ZIP
EMAIL ADDRESS (Option
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)
OCCUPATION (Do not leave blank)
DATE OF BIRTH
VOTER REGISTRATION VUID NUMBER
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(if applicable)
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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'
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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.
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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.
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I further swear that the foregoing statements included in my application are in all things true
and correct."
F G
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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: -
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(See Section 1.007)
Date Itecely d Signature of City Secretary
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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