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Angelina Kiser - Place 62 -21 prescribed by Secretary of Sta to s-u.n 141.034 Chapters 143 and 144J"—Election C-de ]2/2015 ^ APPLICATION FOR A PLACE ON THEW IC'_1� �1� (� /�I 1�1U GENERAL ELECTION BALLOT TO: City Secretary/Secretary of Board 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.) 17�INDICATE TERM CJl �j (�U,kc*) , �'���� ' ElUNE El UNEXPIRED FULL NAME (First, Middle, Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT PERMANENT RESIDENCE ADDRESS (Do not include a P.O.- Box or Rural PUBLIC MAILING ADDRESS (Campaign.mailingaddress, if available,) Route. If you do not have a residence address, describe the address at which you receive personal mall and location of residence,) CI Vi 1 ' ��-� (� q 1� Ic'_r` -o-�11- x!/1'2 jq o cl 14 ber"E_ J ka I'Yl, CITY 40,CCUPATION CITY STATE ZIP PUBLIC EMAIL ADDRESS (if available) o not leave blank) DATE OF BIRTH VOTER REGISTRATION VUID NUMBER (Optional)-' okige',r ,sa+c, cc,Cpvv TEL EPHONE CONTACT INFORMATION (Optional) LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN Home; I b y • �� � —�G� 2U IN STATE IN TERRITORY ELECTED FROM Work: �. I CJ -- � � Ci ) l -7L . year (s) 4 / year (s) Z 10 — Cell: �` _ 6(D� 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 leastthree years prior to this election, �] Before me, the undersigned authority, on this day personally appeared (name) who being by me here and now dully sworn, upon oath says: "I, (name) A no 1 `�`� of County, Texas, being a candidate for the office of e ' w€ 2 11.' ( swear that I will support and defend the Consiitution-and laws of the United States and of the State of Texas, am a citizen of the United States eligible to hold such office under the constitution and laws of this slate. 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, l 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 thatthe foregoing statements Included in.my application ar In all things true and correct" r SIGNATUR �.�.. Sworn to and subscribed before me at- c �a this the me day of ®% BRENDA LOUISE DENNIS NO$IW PUBLIC STATE UE TEXAS a My Commission Wires 11.03 -1 Signature of Officer Administering Oath2 Title of Officer Administering Oath TO BE COMPLETED BY CITY SECRETARY OR SECRETARY OF BOARD: I, '(See Section 1.007) l:..... t . `� E , k•' Date Received Signature of Secretary ..Voter Registration Status Verified ET ED n a -tr�mn QI Ictin Texts 7R711 -2070 (512) 463 -5800 (TDD 1 -800- 735 -2989) IC7.dJ CLI IflS I�UII11111JJl Ul l -- - APPOINTMENT OF A CAMPAIGN TREASURER FORM CTA BY A CANDIDATE PG � 1 Total pages filed; See CTA Instruction Guide for detailed instructions. „I 2 CANDIDATE MSI MRS IMR FIRST MI OFFICE USE ONLY NAME A����Pa�yla �: i. Acct # NICI"E 'LAST SUFFIX Date Recelved �.� 6 f�j►r' r� 3 CANDIDATE ADDRESS I Po BOX; APT I SUITE t, CITY; STATE; ZIP CODE MAILING } �Ct�C� CtII��MSCAVt�I ADDRESS - ,Ddl CA1 Z, `lg� 4 CANDIDATE AREA CODE PHONE NUMBER EXTENSION Date Handdellve2dorPostrnarked PHONE Date Processed l U \ 3q % J Date Imaged 5 OFFICE HELD (if any) 6 OFFICE SOUGHT _ I /Y @ C � Z C T t� itl- 1 (if knDWn) .tot) 7 CAMPAIGN MSIMRS/MR FIRST MI NICKNAME LAST SUFFIX TREASURER NAMEY1 _ uL�. T.t Sei 8 CAMPAIGN STREET ADDRESS (NO PO BOX PLEASE); APT ISUnf,, CITY; STATE; ZIP CODE TREASURER( t tCLN��9 `�V�GIVI� STREET ADDRESSWI� ` Z/ �' �(•� (residence or business) 9 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION TREASURER PHONE C`��U 3C( 3 0 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. J Signature fCandidate Date Signed GO TO PAGE 2 www.ethics.state.tx.us Revised 07/14/2010 m n aw 12070 Ai isfin Texas 78711-2070 (512) 463 -5800 (TDD 1 -800- 735 -2989) CODE F FAIR I FORM CFCP COVER SHEET C'C 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 Campaign Practices. The Code maybe filed with the proper filing r 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 HanddellveedorPoshnalced 1997, may subscribe to the code at any time. Date Processed Subscription to the Code offair Campaign Practices is voluntary. Date Imaged 1 ACCOUNT NUMBER 2 TYPE OF FILER (Ethics Commission Flem) V CANDIDATE POLITICAL COMMITTEE If tifing as a candidate, complete boxes 3 - 6, If filing for a pofftical committee, comp /ete Men 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 (PLEASETYPEORPRINT) An je.11 )go- / c NICKNAME LAST SUFFIX (SR., JR., III, eta) 6 or 4 TELEPHONE NUMBER AREA CODE PHONE NUMBER EXTENSION OF CANDIDATE (PLEASETYPEORPRIN1) 5 ADDRESS OF CANDIDATE STREET/POBOX; APT/SUFTE#, Crn° STATE ZJP CODE (PLEASETYPEOR PRINT) 6 OFFICE SOUGHT BY CANDIDATE (PLEASE TYPE OR PRINT) 7 NAME OF COMMITTEE (PLEASETYPE OR PRINT) 8 NAME OF CAMPAIGN TAE (Dr., Mc, Ms_, eta) FIRST MI TREASURER /4)qo— Ii✓1 I-T. T; (PLEASE TYPE OR PRINT) . . . . . . . . . . . . . . . . , . . . , . . . NICIWAME . . . . . . . . . . . . . . SUFFIX(SR-, JR-, III, eta) ] /yLAST GO TO PAGE 2 www.ethics.state.tx.us Revised 11/23/2010 Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711 -2070 (512) 463 -5800 (TDD 1 -BDO- CODE OF FAIR CA RAIGN PRACTICES There are basic principles of decency, honesty, aadfairplaythat every candidate andpolitical committee iatbis state has amoral obligationto observe anduphold, inorderthat, after vigorously contestedbut fairly conducted campaigns, our citizens may exercisetheir constitutionalrights to afree anduntrammeled choice andthe will ofthe people maybe My and clearly expressed onthe issues. 0100IM9911639 (1) I will conductthe campaign openly and publicly and limit attacks on my opponeatto legitimate challenges to my opponent's record and stated positions on issues. (2) I willnotuse orpermitthe use of character defamation, whispering campaigns, libel, slander, or scumlous 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 notuse 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 iategrity or patriotism of my opponent (5) I will not undertake or condone any dishonest or unethical practice thatten ds to corrupt or und( -,=e 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 atintimidatingvoters or discouuragingthemfrom 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 in any activity aimed at intimidating voters or discouraging them from voting. () I will immediately and publicly repudiate methods and tactics that may come from others that I have pledgednot to use or condone. I shalltake firm action against any subordinate who violates any provision ofthis code or the laws governing elections. I, the undersigned, candidate for election to public office in the State of Texas or campaign treasurer of apolitical committee, herebyvolunt olyendorse, subscribe to, and solemnlypledge myselfto conductthe campaign in accordance with the above principles and practices. Signature Date www.ethics,state.tx.us Revised 11/23/2010