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)
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► . ;: 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
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