Eric Beam - Place 7p'
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Section 141.031, Cha /Iters 143 and 144, Texas Election Code
12/2015
All information is required to be provided unless indicated as optional
APPLICATION FOR A PLACE ON THE t o S(,1 –e rt 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
FULL
C t'a f�C �� ( ci! 7
UNEXPIRED
FULL NAM (First, Middle, Last)
PRINT PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT
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PERMANENT RESIDENCE ADDRESS (Do not Include a P.O, Box or Rural
PUBLIC MAILING ADDRESS (Campaign mailing address, if available,)
Route. If you do not have a residence address, describe the address
at which you receive personal mail and location of residence,)
15-70 hA rv\Qr e C U'A - -Ae
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CITY
STATE
ZIP
CITY
C
STATE
ZIP
7T) v
PUBLIC EMAIL ADDRESS (if available)
OCCUPATION (Do not leave blank)
DATE OF BIRTH
VOTER REGISTRATION VUID
NUMBER (Optional)'
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Sef,K S ,0 re
a l d liq�
TELEPHONE CONTACT INFORMATION (Optional)
IINGTH OF CONTINUOUS RESIDENCE
AS OF DATE APPLICATION SWORN
Home;
IN STATE
IN TERRITORY ELECTED FROM
work: d,16 �' 2e��(���
year
year
Cell: ®° �! J �j'
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 three years prior to this election.
Before me, the undersigned authority, on this day personally appeared (name) who being by me
here and now duly sworn, upon oath says:
j�
"i, (name) 1,� P, e 'i G"
�q of County, Texas, being a
candidate for the office of t,,I j c, , I LJ L4—c e,. T , swear that I will support and defend the Constitution and laws
of the United States and of the State of Texas. I am 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 law, Chapter 573, Government Code.
I further swear that the foregoing statements included in my application are in all things true and correct."
X
SIGNATURE OF CANDIDATE
Sworn to and subscribed before me at 1` this the Z ay of j ')
SEApONNA R,SCH
NOTARY PU
(y '. STATE OF T
Ck:..
Si ature of Officer Administering Oath z Tit"OfOfficIrAdmitAstering Oath My Commission Expir ;
TO BE COMPLETED BY CITY SECRETARY OR SECRETARY OF BOARD:
1.007) C
(See Section "
Date Received 4,- Signature of Secretary
Voter Registration Status Verified
IOEKEL
LIC
KAS
;12 -01
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711 -2070 (512) 463 -5800 (TDD 1- 800 - 735 -2989)
CODE O'OF FA R CAMPAIGN FORM CoFC°rP
®��'���~( MOVER SHEET
9— �
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 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 Hand - delivered or Postmarked
1997, may subscribe to the code at any time.
Date Processed
Subscription to the Code of Fair Campaign Practices is vohtntaly.
Date Imaged
1 ACCOUNT NUMBER
2 TYPE OF FILER
(Ethics Commission Filers)
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
TITLE (Dr., Mr., Ms., etc.) FIRST MI
(PLEASE TYPE OR PRINT)
y.
. 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
NICKNAME LAST SUFFIX (SR., JR., III, etc.)
®_� (? 6", In
4 TELEPHONE NUMBER
AREA CODE PHONE NUMBER EXTENSION
OF CANDIDATE
(PLEASE TYPE OR PRINT)
J
5 ADDRESS OF CANDIDATE
STREET /POBOX; APT /SUITE #; CITY; STATE; ZIPCODE
(PLEASE TYPE OR PRINT)
6 OFFICE SOUGHT
BY CANDIDATE
(PLEASE TYPE OR PRINT)
spa 4-Al r
7 NAME OF COMMITTEE
(PLEASE TYPE OR PRINT)
8 NAME OF CAMPAIGN TITLE (Dr., Mr., Ms., etc.) FIRST MI
TREASURER
.e i /
m
(PLEASETYPE OR PRINT) !, 4r,, r . . . . . . . . . . . . . . . . . . . . . . . . .
NICKNAME LAST SUFFIX (SR., JR.,111. etc.)
C
GO TO PAGE 2
www.ethics.state.tx.us Revised 11/23/2010
texas ttnics commission N.U. Box 12070 Austin, Texas 78711 -2070 (512) 463 -5800 (TDD 1 -800 -7
i
CODE OF FAIR CAMPAIGN PRACTICES'
.F
There are basic principles ofdecency, honesty, and fair play that every candidate and political committee in this state
has amoral obligation to observe and uphold, in orderthat, after vigorously contested but fairly conducted campaigns,
our citizens may exercise their constitutional rights to a free and untrammeled choice and the will ofthe people maybe
fully and clearly expressed on the issues.
THEREFORE:
(1) I will conduct the campaign openly and publicly and limit attacks on my opponent to legitimate challenges to my
opponent's record and stated positions on issues.
(2) I will not use or permit the use ofcharacter 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 on race, sex, religion, or national origin.
(4) I will not use campaign material of any sort that misrepresents, 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 of my opponent.
(5) I will not undertake or condone any dishonest or unethical practice that tends to corrupt or undermine our system
of free elections or that hampers or prevents the full and free expression ofthe will ofthe voters, including any
activity aimed at intimidating voters or discouraging them from 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.
(7) I will immediately and publicly repudiate methods and tactics that may come from others that I have pledged not
to use or condone. I shall take 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 a political
committee, hereby voluntarily endorse, subscribe to, and solemnly pledge myselfto conduct the campaign in accordance
with the above principles and practices.
Signature
el
�.
Date
www.ethics.state.tx.us Revised 11/23/2010