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Michael H Dahle - Place 62 -21 Prescribed by Secretary of State Section 141.031, Chapters 143 and 144, Texas Election Code 12/2015 All tntormation Is requtrea to ne provfaea unless inalcatea as optional, APPLICATION FOR A PLACE ON THE 06lJ AJ qCP ')X)P 6 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, if any.) INDICATE TERM NCA FULL "sC}I 2— C41y coQAIC L- P CA C- 6 DUNEXPIRED FULL NAME (First, Middle, Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT MIC1lAki— U 9AN1, E PERMANENT RESIDENCE ADDRESS (Do not include a P.O. Box or Rural Route. If you do not have a residence address, describe the address at which you receive personal mail and location of residence,) q / 21, 0 C- YM ► 5*) � /\/ CITY M I,'__NAEL U, DANLE PUBLIC MAILING ADDRESS (Campaign mailing address, if available,) P, ()r P 0)) W C3 STATE I ZIP I CITY STATE I ZIP 54: +& k X I .r) 001 i 4l PUBLIC EMAIL ADDRESS (If available) OCCUPATION (Do not leave blank) DATE OF BIRTH VOTER REGISTRATION VUID NUMBER (Optional)' TELEPHONE CONTACT INFORMATION (Optional) LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN Home: I IN STATE I IN TERRITORY ELECTED FROM Work: 14 4 year (s) I '), year (s) Cell: 3,1 co - 4(q- s x) 2 I month(s) I I a 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 three vears prior to this election. Before me, the undersigned authority, on this day personally appeared (name) MICNA CZ OA14LE who being by me here and now duly sworn, upon oath says: 1, (name) M I C A�_ L f) A H L.0 , of 6 C'X.A County, Texas, being a candidate for the office of SYIiP_-A-VZ <11t) PWX 6 , swear that I will support and defend the Constitution and laws of the United States and of the State of Texas. I am 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 law, Chapter 573, Government Code. I further swear that the foregoing statements included in my application are in all things true and rre R_ SIGNATURE 0 Sworn to and subscribed before me atl t this the day ofi _ Signature of Officer A&ministering Oath Title of Officef Administering Oath TO BE COMPLETED BY CITY SECRETARY OR SECRETARY OF BQAR % (See Section 1.007) ��ir, r�aua} rrueu_ ernrrruuwar _n)rniuurirurnanl /unni ► . ;: uruurrreurrr rrrunrur�ur)pr /r)umnrr)unnarhn� Date Received Signature of Secretary Voter Registration Status Verified n Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711 -2070 (512)44b3 -58UU (I vu 1- u22- isa -Zuou) 1 T E T OF A CAMPAIGN TREASURER FORM CT �BYA CANDIDATE PG 1 I10 CANDIDATE SIGNATURE 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. I am aware of the restrictions in title 15 of the Election Code on contributions from corporatio ap# labor oTanizations. Signature of Candidate Date Signed GO TO PAGE 2 www, ethics. state, Ix. us Revised 07/14/2010 See CTA Instruction Guide for detailed Instructions . 1 Total pages filed: ` f 2 CANDIDATE MS /MRS /)11 FIRST MI OFFICE USE ONLY NAME M 14A Et- ' Acci. a . , . . . , . . NICKNAME , ,LAST . . . . SUFFIX Date Received 3 CANDIDATE ADDRESS /PO BOX; APT /SUITE#; CITY; STATE; ZIP CODE MAILING ADDRESS poX �j 4 CANDIDATE AREA CODE PHONE NUIMER EXTENSION Date HandEeliveredor Postmarked PHONE / 1�l a) jam\ 9 m DLL] -2- ` ` / Date Processed 6 OFFICE Date Imaged HELD (if any) 6 OFFICE SOUGHT P_ ®U lie' L t 7 CAMPAIGN M 7 tR FIRST MI NICKNAME LAST SUFFIX TREASURER NAME f , m® � A J ,t / 8 CAMPAIGN STREET ADDRESS (NO PO BOX PLEASE); APT /SUITE #; CRY; STATE; ZIP CODE TREASURER STREET _ a C) C ADDRESS (residence or business) 5e C1 J "J 8 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION TREASURER PHONE I10 CANDIDATE SIGNATURE 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. I am aware of the restrictions in title 15 of the Election Code on contributions from corporatio ap# labor oTanizations. Signature of Candidate Date Signed GO TO PAGE 2 www, ethics. state, Ix. us Revised 07/14/2010 CANDIDATE / OFFICEHOLDER FORM c/OH CAMPAIGN FINANCE REPORT COVER SHEEN' PG 1 1 Flier ID (Efts Comnhsk)n Filers) 2 Total pages flied: The C /OH Instruction Guide explains how to complete this form. 3 CANDIDATE / MS /MR IMR FIRST MI OFFICEUSEONLY OFFICEHOLDER NAME V L� �;�. Er Dale Recelved NICKNAME LAST SUFFIX q CANDIDATE/ ADDRESS / PO BOX; APT/ SUITE 0; CITY; STATE; ZIP CODE OFFICEHOLDER MAILING ADDRESS Change of Address i�� 5 CANDIDATE/ AREA CODE PHONE NUMBER EXTENSION Date Hand - delivered or Data Postmarked OFFICEHOLDER f �) 6 69'91 0 1 PHONE 6 CAMPAIGN Ms RS MR FIRST MI Receipt 0 Amount $ TREASURE R / <.e' Date Processed NAME ....... NICKNAME LAST SUFFIX Dete imaged PA 7 CAMPAIGN STRUT ADDRESS (NO PO BOX PLEASE), APT I SURE 0; CITY; STATE; ZIP CODE TREASURER ADDRESS � fl � ( (Residence or Business) <.(- 14) J S CAMPAIGN AREA CODE PHONE NUMBER EXTENSION TREASURER PHONE 9 REPORT TYPE January 16 30th day before elacton Runoff 16th d after campaign 9n treasurer appointment (OHlcaholder Orgy) LW UY 16 � all, day before election ❑ Exceeded $600 limit � Fine! Report (AHach C/OH • FR) 10 PERIOD Month Day Year Monti Day Year COVERED THROUGH 11 ELECTION ELECTION DATE ELECTION TYPE Month Day Year ❑ Primary ❑ Runoff ❑ Other' Description . A a /0 0 9i Ix Oeneral E] Spoolal 12 OFFICE OFFICE HELD Harry,) 13 oFFIcE SOUGHT pr kr»vm) �A � 4,�A GO TO PAGE 2 Forms provided by Texas Ethics Commission www.ethics.slate.lx.us rievisau aioczV 10 CANDIDATE / OFFICEHOLDER F=ORM C /OH CAMPAIGN FINANCE REPORT COVER SHEET PG 2 19 C /OH NAME 15 Flier ID (Ethics Commission Fliers) `` A NIL 16 NOTICE FROM THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO POLITICAL SUPPORT THE CANDIDATE / OFFICEHOLDEH. THESE EXPENDITURES AMY HAVE SEEN AIAVE WITHOUT THE CANOIOATA7 S OR OFFICEHOLDERS COMMITTEE(S) KNOWLEDGE OR CONSENT. CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE OF SUCH EXPENDITURES, COMMITTEE TYPE COMMITTEE NAME GENERAL" COMMITTEE ADDRESS 11SPECIFIC COMMITTEE CAMPAIGN TREASUREH NAME F] Additional Pages COMMITTEE CAMPAIGN TREASURER ADDRESS 17 CONTRIBUTION 11 TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THAN TOTALS PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED 2. TOTAL POLITICAL CONTRIBUTIONS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS) EXPENDITURE TOTALS 3. TOTAL POLITICAL EXPENDITURES OF $100 OR LESS, UNLESS ITEMIZED A. TOTAL POLITICAL EXPENDITURES CONTRIBUTION BALANCE 5, TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY OF REPORTING PERIOD OUTSTANDING 8, TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE LOAN TOTALS LAST DAY OF THE REPORTING PERIOD 18 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the accompanying report is true and correct and Includes all nformalion required to be reported by me under Title 15, Election Cod DONNA R. SCHMOEKEL NOTARY PUBLIC r r, My Commission STATE OF TEXAS Signature of Candidate or Officeholder Expires 12 -01 -2019 AFFIX NOTARY ST before by the X4 6 this the Sworn to a sub ribed me, said day of 20 to certify which, witness my hand and seal of office. Signature of officer administering oath Printed name of officer administering oath Title Of officer adminlatering oath Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015 G