Carl Douglas - Place 1I'm
1-2A
Prescribed by Secretary of st--
Sectlon 141.03 1, chapters 143 and 144j"—Election Cade
12/2015
All information is required to be proviaeo unjessjj_jUj�d — UP LI
APPLICATION FOR A PLACE ON THE — /I GENERAL ELECTION BALLOT
TO: City Secretary/Secretary of Bo4rd
I requestthat 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
,�
A FULL
Lj AA ( 1i
e - J,� 'h
UNEXPIRED
NAME (First, Middle, Last)
PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT
(FULL
pip,L_�- C-1
Ak
PERMANENT RESIDENCE ADDRESS (Do no-6include a P.O: Box or Rural
PUBLIC MAILING ADDRESS (Campaign. ai ling address, if avails ble.)
Route, if YOU db not have a residence address, describe the address
at Which you receive personal mail and locatil f -d nce.)
M
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193 N51 t 4-
CITY STATE ZIP CITY
STATE zi
PUBLIC EMAIL ADDRESS (if available) CCUPATIDN (Do not ave blank) DATE OF BIRTH
VOTER REGISTRATIDN VUID
NUMBER (Optlonal)'
TELEPHONE CONTACT INFORMATION (Optional) LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN
Home: 5 10 IN STATE IN TERRITORY ELECTED FROM
year(s) year (s)
Work: Aj
month(s) month(s)
Cell: t4
If using a nickname as part ofyour name to appear on the ballot, you are also signing and swearing to the following statements: I further swear
have been
that my nickname does not constitute a slogan nor does it Indicate a political, economic, social, or religious view or affiliation. I
Commonly known by this nickname for at leastthree years prior to this election,
A I
day appeared (name)_4� Q k FF% who being by me
Before me, the undersigned authority, on this personally
here and now duly sworn, upon oath says:
"I, (name) 4 of k mo � County, Texas, being a
-
candidate fortheofficeof �Che*� swearthat l,will suppo and defend the Constitution and laws
of the United States and of the State of Texas, I am a tizan 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 sw reg application are In all things true and correct'
DA LOUISE
DENNIS
X`
NOTARY PUBLIC
STATE OF TEXAS
MY COMMM16n Tres 11 SIGNATURE 0 FICAN D I D ATE
Sworn to and subscribe e ore this the ------ 3Y oi( 1A ia
C SEAL
Signature of Officer Administering 0ath2 Title of ONcer Administering QVl
TO BE COMPLETED BY CITY SECRETARY OR SECREJ,�ARY�OF�qBOARD-
(See Section 1,007)
Date Received Signature of Secretary
.Voter Registration Status Verified
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711 -2070 (512) 463 -5800 (TDD 1 -800- 735 -2989
APPOINTMENT OF A CAMPAIGN TREASURER FORtUI CTA
BY A CANDIDATE PG 1
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.
l am aware of the restrictions in title 15 of the Election Code on contributions
from corporations and labor organizations. /` %
nn 0 ....anrc7n &" +ice T.— 7a711_ ?mn (512) 463 -5800 (TDD1- 800 - 735 -2989)
www.ethics.state,tx.us . ' Revised um4rzuiu
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FORM CTA
CANDIDATE MODIFIED
REPORTING DECLARATION PG 2
11 CANDIDATE
NAME
6. /
r.
Y.
12 MODIFIED
COMPLETE THIS SECTION ONLY IF YOU ARE
REPORTING
DECLARATION
CHOOSING MODIFIED REPORTING
-• 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 $500 in political contributions or
make more than $500 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, 1 will be
required to file pre - election reports and, if necessary, a runoff
report.
.�p)?
�r-•`+� r �`'' t %
ZaL-
Year ofelection(s)ror election cycle tq Signature of Candidate
which declaration applies
This appointment is effective on the date it is filed with the appropriate filing authority.
www.ethics.state,tx.us . ' Revised um4rzuiu
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A..'.l;.. T ., -, 7R711_'Xn7n /F1'71 dR3 -5800 FFDD 1-800- 735 -2989)
I CXdS CU 11L.� uut I II I I[JJIUI I -- -
CODE OF FAIR CAMPAIGN FORM CFCP
COVER SHEET
PRACTICES
OFFICE USE ONLY
Pursuant to chapter 25 8 of the Election Code, every candidate and
Date Received
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,
Date HanddellveredorPostmatted
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 Filers)
E] 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
TF LE (Dr., Mr., Ms., etc,) FIRST MI
(PLEASETYPEOR PRIMA
• 2 . . • •
$d
Ill,
NICIWAME LAST SUFFIX (SR-, JR., eta) .
a'
4 TELEPHONE NUMBER
AREA CODE PHONE NUMBER EXTENSION
OF CANDIDATE
` „.`
(PLEASETYPE OR PRIM'
5 ADDRESS OF CANDIDATE
STREET I PO BO>; APT /SUrrEt. r CI Y sTA ZIP CODE
I ,...,.
(PLEASETYPEORPRINT)
P -
r� d
6 OFFICE SOUGHT
BY CANDIDATE
° r
� m „� "�''. � ,,, ��
�°_ e
(PLEASE fYPEORPRINT)
7 ' NAME OF COMMITTEE
(PLEASETYPE OR PRIM
8 NAME OF CAMPAIGN TITLE (Dr- ,Mr- ,Ms.,etc) FIRST MI
TREASURER
(PLEASETYPEORPRIN) . . . . . . . . . .
NICtWAME SUFFIX(SR, JR II, eta)
N
GO TO PAGE 2
www,ethics. state. bc.us Revised 11/23/2010
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711 -2070 (512) 463 -5800 (TDD 1 -800-
CODE OF FAIR CA RAIGN PRACTICES
There are basic principles of decency, honesty, and fair playthat every candidate and political committee inthis state
has amoral obligationto observeanduphold, inorderth4 after vigorously contestedbut fairly conducted campaigns,
our citizens may exercisetheir constitutionalrights to afree anduntrammeled choice andthewill ofthe people maybe
fully and clearly expressed ofthe issues.
ill' �! • •
(1) I will conductthe campaign openly andpublicly and limit attacks onmy opponentto legitimate challenges to my
opponent's record and stated positions on issues.
(2) Iwillnotuse orpermittheuse 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) Iwillnotuse campaign material of any sortthatmisrepresents, 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 or patriotism ofmy opponent.
(5) I will not undertake or condone any dishonest or unethical practice thattends to corrupt or undermine our system
of free elections or that hampers or prevents the full and free expression ofthe will of the voters, including any
activity aimed atintimidatingvoters or discouragingthem from voting.
(6) I will defend and uphold the right of every qualified voter to full and equal participation in the electoral process,
andwM not engage in any activity aimed at intimidating voters or discouraging them from voting.
(7) I will immediately and publicly repudiate methods and tactics thatmay 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, herebyvoluntarilyendorse, subscribe to, and solemnlypledge myselfto conductthe campaign in accordance
with the above principles and practices.
f`
Date= ,
www, ethics, state. tx. us Revised 11/23/2010