Glen Outlaw - Place 21.21
Pre t&bmd by 5,2ctet at yo I Mate
Seth 141,031, Chapters 143 and 144, Texas Ek-di" 06d0
I
All Information is reaufred to be orovIded unless Indicated as ootlona[
APPLICATION FOR A PLACE ON THE 62ovGmi3�6-1 1P, . Zt->i GENERAL ELECTION BALLOT
TO! City Secretary/secretary of Board
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, It any,)
INDICATE TERM
[-�;71
LA-i
7- L PLPVC-e
FU LL
a_ UNEXPIRED
FULL NAME (First, Middle, Last)
PRINT NAME AS YOU WANT IT TO APPEAR ON THE BACC6i-
00--T" -U0
G-C-E:t3 0",TLAk,3
PERMANENT RESIDENCE ADDRESS (Do not include a P.O. Box or Rural
PUBLIC MAILING ADDRESS (Campaign rnallIng address, It available.)
Route, If you do not have a residence address, describe the address
at which you receive personal mail and location of residence.)
0 A4-1r-
STATE-, ZIP
e-- rtE 2-,T- 76,
PUBLIC EMAIL ADDRESS (If available)
OCCUPATION (Do not leave blank)
DATE OFBIRTH
VOTER REGISTRATION VUID
Pr t!-%k
Ic- -rI
NUMBER (Optional)
TELEPHONE CONTACT INFORMATION (Optional)
LENGTH OF CONTINUOUS RESIDENCE
AS OF DATE APPLICATION SWORN
Home: 21v 7E3�o
IN STATE
IN TERRITORY ELECTED FROM
Work:
Z 7 year (s)
2-7 year (s)
Cell:
month(s)
month(s)
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 threeaq_j#ior to tills election.
Before me, the undersigned authority, on this day personally appeared (name CXA,,T FAQ who being by me
here and now duly sworn, upon oath says.
11, (name) a LctJ 1?- QL/- 7L-PL,--) of LL a LL4 PE County, Texas, being a
candidate for the office of C A I
gJ2-r ?-- rY Cox > CA t- &t+c-e swear that I will support and defend the Constitution and laws
of the United States and of the State of Texas. I afti 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 low, chapter 573, Government Code,
I further Swear that the foregoing Statements Included In my application are in all things true and correct.'
X BRENDA LOUISE DENNIS
L C/TGIV Aft yJ
I
SIGNATURE Oil FUDLIU
Sworn to and subscribed before nap at,LU�Q-' this thpt-day of My Commisabn Expires 11 0318
ti
ignature of Offices Administering Title of O leer Ad g OAhl-,
(See Section 1TO BE COMPLETED BY CITY SECRETARY OR SECRETARY OF 8QARD,
,007) I Lo
I
Voter Registration Status Verified Date Received -,-SJga#Wr—e of Secretary
IeXaStinicsuommission t'. U.bOX'IZU /U F\ustin, texas tbt- i "I -ZU /U (b]Z)4b3 -btSUU
APPOINTMENT 1 TREASURER
Y A CANDIDATE
2 CANDIDATE
NAME
3 CANDIDATE
MAILING
ADDRESS
4 CANDIDATE
PHONE
See CTA Instruction Guide for detailed instructions.
MS /MRS MR FIRST MI
(� `R-.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
NICKNAME LAST SUFFIX
CXA Tt- A-�
ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE
3 7Z q i,12-5 y ►—F� {�� I�I� I <crt-,n -r-& i- 7 ,51 s--t
AREA CODE PHONE NUMBER
{ l O) 6, 5-,i ` 76),
EXTENSION
lu 'I- twu— ('50—ZWjs j)
FORM CTA
PG 1
1 Total pages filed:
1
OFFICE USE ONLY
Acct #
Date Received
n '
Date Hand - delivered or Postmarked
Date Processed
8 CAMPAIGN
TREASURER
STREET
ADDRESS
(residence or business)
9 CAMPAIGN
TREASURER
PHONE
10 CANDIDATE
SIGNATURE
STREETADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE; ZIP CODE
S %G i F� P� ,l 7-14 PA 9-V- , �Cwr +E(z-i -"?- —IX %81
AREA CODE PHONE NUMBER EXTENSION
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.
am aware of the restrictions in title 15 of the Election Code on contributions
from corporations and labor organizations.
AIL caf 2� �t L
Signature of Candidate Date Signed
GO TO PAGE 2
www.ethics.state.tx.us Revised 07/14/2010
texas Ctntcs uommission r.U. box 1Zulu Austin, texas /ti /11 -"tutu
CODE OF FAIR CAMPAIGN
PRACTICES
(b 12) 4b3 -b6UU (I UL) 1 -duu-
Pursuant to chapter 258 of the Election Code, every candidate and
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,
1997, may subscribe to the code at any time.
Subscription to the Code ofFair Canlpuign Practices is voluntary
•
i
OFFICE USE ONLY
Date Received
Date Hand - delivered or Postmarked
Date Processed
Date Imaged
1 ACCOUNT NUMBER 2 TYPE OF FILER
(Ethics Commission Filers)
CANDIDATE X 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) fin (rL C,
' .........................
NICKNAME LAST SUFFIX (SR., JR., III, etc.)
OL,,-i L-A7,L,-)
4 TELEPHONE NUMBER AREA CODE PHONE NUMBER EXTENSION
OF CANDIDATE r /y
(PLEASE TYPE OR PRINT) t 7 —
5 ADDRESS OF CANDIDATE STREET /PO BOX; APT /SUITE #; CITY; STATE; ZIP CODE
(PLEASE TYPE OR PRINT) v _ " (:C_ "f jZ71— TY_ 78P5_4
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 MI
TREASURER
(PLEASE TYPE OR PRINT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
NICKNAME LAST SUFFIX (SR., JR., III, etc.)
Ou�_-r "xu_)
www.ethics.state.tx.us Revised 11/23/2010