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Bert Crawford - Place 72 -21 Prescribed by secretary of State Section 141,031, Chapters 143 and 144, Texas Election Code 12/2015 All Informatinn is renuired to he nrovided unless indicated as ontinnal APPLICATION FOR A PLACE ON THE 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 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 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,) CITY STATE ZIP CITY STATE ZIP 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: IN STATE IN TERRITORY ELECTED FROM Work: year (s) year Cell: f 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: "I, (name) of County, Texas, being a candidate for the office of 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 this the r day of t SENNNA R. SCHM NOTARY PUB STATE OF TE Signature of Officer Administering Oath Title o Officer(Admini tering Oath MY Commission Expires BE BY CITY SECRETARY OR SECRET F BOARD: (oe S colon 1007) --2-0/ tl Rec6lved ` ; Signature of Secreta Voter Registration Status Verified EKEL C S x-01 -2019 Texas Ethics Commission P.O. Box 12070 Austin. Texas 78711 -2070 (512) 463 -5800 (TDD 1- 800 - 735 -2989) APPOINTMENT OF A CAMPAIGN TREASURER FORM CTA BY A CANDIDATE PG 1 1 Total pages filed: See CTA Instruction Guide for detailed instructions. 2 CANDIDATE MS /MRS /MR FIRST MI OFFICE USE ONLY NAME Acct. # . . NICK . NAME . . . . . . . . . . . L . AST . . . . . . . . . . . . . . . . SUFFIX . . . . . . Dale Received r i 3 CANDIDATE ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE!` MAILING , ADDRESS 9. r / 4 CANDIDATE AREA CODE PHONE NUMBER EXTENSION Date Hand - delivered or Postmarked PHONE Date Processed 5 OFFICE Date Imaged HELD, (if any) 6 OFFICE SOUGHT (if known) 7 CAMPAIGN MS /MRS /MR FIRST MI NICKNAME LAST SUFFIX TREASURER NAME 8 CAMPAIGN STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE; ZIP CODE TREASURER STREET ADDRESS (residence or business) 9 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION TREASURER PHONE 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. I am aware of the restrictions in title 15 of the Election Code on contributions from corporations and labor organizations. f� SignA re of Candidate Date Signed GO TO PAGE 2 www.ethics.state.tx.us Revised 07/1412010 Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711 -2070 (512) 463 -5800 (I'DD 1- 800 - 735 -2989) CODE OF FAIR CAMPAIGN FORM CFCP PRACTICES CTICES COVER SHEET 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 appointme'nt form. Candidates or political committees that already have a�, current campaign treasurer appointment on file as of September 1, Date Hand-deliveredorPostmarked ' 1997, may subscribe to the code at any time. Dale Processed Subscription to the Code gfFair Campaign Practices is voltmtaly. Date Imaged 1 ACCOUNT NUMBER 2 TYPE OF FILER (Ethics Commission Filers) CANDIDATE Fj POLITICAL COMMITTEE ff 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NICKNAME LAST . . . . . . . . . . . . . . . . . . SUFFIX (SR., JR., III, etc,) 4 TELEPHONE NUMBER AREA CODE PHONE NUMBER EXTENSION OF CANDIDATE r \ (PLEASE TYPE OR PRINT) 5 ADDRESS OF CANDIDATE STREET PO BOX; APT /SUITE CITY; STATE; ZIPCODE (PLEASE TYPE OR PRINT) 6 OFFICE SOUGHT BY CANDIDATE (PLEASE TYPE OR PRINT) 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.) GO TO PAGE 2 www.ethics.state.tx.us Revised 11/23/2010 Icnaa�unw%..vllninssiulI r- .U. 6uX ILU /u Husun, IeXas /u/ I I -ZU /u (bl2)4w -bbuu (IUU'I -buu- There are basic principles of decency, honesty, and fair play that every candidate and political committee in this state has amoral obligation to observe and uphold, in order that, 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 orpermit the use of character defamation, wh ispering 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 sortthat 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 of the will of the voters, including any activity aimed at intimidating voters or discouraging them fi-om voting. (6) I will defend and uphold the right of every qualified voter to f it I and equal participation in the electoral process, and will not engage in any activity aimed at intimidating voters or discouraging them from voting. (7) Twill inunediately 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 of this 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, hereby voluntarily endorse, subscribe to, and solemnly pledge myself to conduct the campaign in accordance with the above principles and practices. Signature Date www.ethics.state.tx.us Revised 11/23/2010