Allison Heyward2 -21
Prescribed by Secretary of State
Section 141.031, Chapters 143 and 144, Texas Election Code
1/2017
ALL INFORMATION IS RFOUIRED TO BE PROVIDED UNLESS INDICATED OPTIONAL
APPLICATION FOR A PLACE ON THE u / Le O 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 NAMI` (First, Middle, Last)
PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOTI
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111504
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PERMANENT RESIDENCE ADDRESS (Do of 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.)
S� �%/
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�Gi � Y�ahSr�
/
CITY
STATE
ZIP
CITY
STATE
ZIP
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PUBLIC EMAIL ADDRESS (if available) OCCUPATION (Do not leave blank) DATE OF BIRTH VOTER REGISTRATION VUID
�_ NUMBER (Optional) 2
5ub"4r1,4e �C'qc42 3 -23/
TELEPHONE CONTACT INFORMATION (Optional) LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN
Home: IN STATE IN TERRITORY FROM WHICH THE
OFFICE SOUGHT IS ELECTED3
Work: IFJ year (s) year (s)
Cell: lc)) q5,1— -,:2 q G 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) �� 1 5 ®� ` VV [lhp 1.lC�I i t l d, who being by me
here and now dully sworn, upon oath says:
r
"I, (name) 4/I o -,- r e n � Z� of `( �'G�`y'C` /`1 1-2 -e County, Texas, being a
candidate for the office of C� 4- 4'(c.: '' swear that I will support and defend the Constitution and laws
of the United States and of the Stat 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 co e "
SIGNAT 1 DID TEp .; r
Sworn to and subscribed before me at this the
i -ly Cmwnission Expires 11 0318
�Q=
Signature of Officer Administering Oath 4 Title of Officer Administering Oath
TO BE COMPLETED BY CITY SECRETARY OR SECRETARY-OF BOARD:
(See Section 1.007) _ `
Date Received Sig azure of Secretary
�/
Voter Registration Status Verified 44
APPOINTMENT OF A CAMPAIGN TREASURER FORM PTA
BY A CANDIDATE PO 1
See CTA Instruction Guide for detailed instructions.
1 Total pages filed:
r
2 CANDIDATE
MS (Ss y MR FIRST MI
OFFICE USE ONLY
NAME
M
Filer ID #
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
NICKNAME LAST SUFFIX
Lo a, (—A-
Date Received _
?' I
3. CANDIDATE
ADDRESS / PO BOX; APT / SUITE #, CITY; STATE; . ZIP CODE
MAILING
ADDRESS
�r� ^� �
2 `r ` �S�I e +{ s
��
+`,J , r+
� ` LA C> �( j �I/ �
Date Hand - delivered or Postmarked
4 CANDIDATE
AREA CODE PHONE NUMBER EXTENSION
Receipt#
Amount$
PHONE
Date Processed
5 OFFICE
Date Imaged
HELD
(if any)
6 OFFICE
SOUGHT
1
C Cc n CL
(if known)
0 l 1
7 CAMPAIGN
MS/ MR FIRST MI NICKNAME LAST SUFFIX
TREASURER
NAME
8 CAMPAIGN
STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #, CITY; STATE; ZIP CODE
TREASURER
�2Z ��� `✓ r��
STREET
ADDRESS
(residence or business)
9 CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
») 30 5 - Lf (b '43
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.
uL. l t�
.41nature of C ndidate Date Signed
i
GO TO PAGE 2
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 1217/2017
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711 -2070 (512) 463 -5800 (TDD 1- 800 - 735 -2989)
CODE OF FAIR CAMPAIGN
FORM CFCP
PRACTICES
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
'7 —or'& I
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.
Subscription to the Code of Fair Campaign Practices is voluntary.
Date Processed
Date Imaged
I 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
(PLEASETYPEORPRINT)
A SC1�J
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
NICKNAME LAST
. . . . . . . . . . . . . . . . . .
SUFFIX (SR., JR., III, etc.)
4 TELEPHONE NUMBER
AREA CODE PHONE NUMBER
EXTENSION
OF CANDIDATE
(PLEASE TYPE OR PRINT)
! I�I `
l
ADDRESS OF CANDIDATE
STREET/ PO BOX; APT /SUITE #, CITY;
STATE; ZIP CODE
(PLEASETYPE OR PRINT)
6 OFFICE SOUGHT
BY CANDIDATE
(PLEASE TYPE OR PRINT)
7 NAME OF COMMITTEE
(PLEASE TYPE OR PRINT)
At'5 0-A 4 C., Corn
vj
0r. 0
8 NAME OF CAMPAIGN
TITLE (Dr., Mr., Ms., etc.) FIRST f
MI
TREASURER
1 l0-t-
�V +$,, f1 Y 5 [_ e 4
(PLEASE TYPE OR PRINT)
. . . . . . . . . . . . . . . . . . . . . . . . .
, . . . . . . . , _ . . . .
NICKNAME LAST
`J (2, f e
SUFFIX (SR., JR_ ill, etc.)
GO TO PAGE 2
www.ethics.state.tx.us Revised 11/2312010
IexaS Ctnics uommission F-U BOX "I Zulu Austin, Texas R9/"I"1 -zuiu (b1Z) 4bS -btiuu (I UU "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 anduphold, in order that, aver 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.
1152149110 i77 i
(1) 1 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 of character 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) 1 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 of the will of the 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) 1 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 conductthe campaign in accordance
with the above principles and practices.
2,3
Signature
Date
www.ethics.state.tx.us Revised 11/23/2010