Allison Heyward2 -21
Prescribed by Secretary of State
Section 141.031, Chapters 143 and 144, Texas Election code
1/2017
ALL INFORMATION IS REQUIRED TO BE PROVIDED UNLESS INDICATED OPTIONAL
APPLICATION FOR A PLACE ON THE av GENERAL ELECTION BALLOT
TO: City Secretary /Secretary of Board C 4
( ;,C- Selnz t +-X_
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
UNEXPIRED
FULL NAME JFirst, Middle Last)
PINT A,ME AS YOU Wp► IT TO APPEAR O THE BALLOT'
PERMANENT RESIDENCE ADDRESS (Do not include a P.9!/ Box or Rural
PUBLIC MAILING ADDRESS (C- 'rnpaign mailing address, if available.)
Route. If you do not have a residence address, describe the address
_ - -�
a ich 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
CL Ir C A m' v -- NUMBER (Optional)z
TELEPHONE CONTACT INFORMATION (Optional) LEITH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN
Home: _ IN STATE IN TERRITORY FROM WHICH THE
_
`i OFFICE SOUGHT IS ELECTED
Work-. - '
J year (s) / n— year (s)
Cell: r �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)24 I ( 56'- WF- who being by me
here and now duly sworn, upon oath says:
"l, /�
"I, (name) A 11 1 5� f ,/ - 'w G ✓Z/% / of C1 L-,o )4f'ZU -e- County, Texas, being a
candidate for the office of v bn r 1 6_( —swear that I wills pport 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."
SICAATUIRE OF CANDIDATE
Sworn to a d subscribed before me at this the day of
SEAL
r j
Signature of Officer A inistering Oath4 Title of fncer AdWinisterin ath
TO BE COMPLETED BY CITY SECRETARY OR SECRETARY OF BOARD: ED SON
- /
(See Section 1.007) AS
Date Received ature of Sec, to 1DI124452t3 t
Voter Registration Status Verified L� My IumPfton Expu� 03/172025
APPOINTMENT OF A CAMPAIGN TREASURER FORM CTA
BY A CANDIDATE
PG 1
See CTA instruction Guide for detailed instructions.
1 Total pages filed:
1
2 CANDIDATE
MS R ` R FIRST
MI
OFFICE USE ONLY
NAME
A—A) S ve)
Filer ID #
--------------- - - -- -- ---- ----------
NICKNAME
- - - - --
SUFFIX
Date Received
, 'LAST
3 CANDIDATE
ADDRESS PQ I A / SUITE M CITY; STATE;
ZIP CODE
MAILING
ADDRESS
— —
Date Hand - delivered or Postmarked
4 CANDIDATE
AREA CODE PHONE NUMBER EXTENSION
Receipt#)
Amount$
PHONE
— T
Date Processed
5 OFFICE
HELD
C
rn
Date Imaged
(if any)
C )n C t� �� VWA
��
6 OFFICE
SOUGHT
known)
Ro
(if
, 0, �y� G
7 CAMPAIGN
MS /MRS /MR FIRST MI NICKNAME
LAST SUFFIX
TREASURER
NAME
�
,411 I
wa yrc�
8 CAMPAIGN
STREET ADDRESS; APT /a SUITE; CITY;
STATE; ZIP CODE
TREASURER
a
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.
a` u 2
�.�i nature of Candidate
Date Signed
GO TO PAGE 2
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 4/2/2021
0C.0'ODE OF FAIR CAMPAIG-4
Pursuant to chapter 258 of the Election Code, every candidate and
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,
1997, may subscribe to the code at any time.
Subscription to the Code of Fair Campaign Practices is voluntary.
I ACCOUNT NUMBER
(Ethics Commission Filers)
i
2 TYPE OF FILER
CANDIDATE
FORM C:FCP
COVER SHEET
OFFICE USE ONLY
Date Received
q1[q1;w4
Date Hand - delivered or Postmarked
Date Processed
Date Imaged
POLITICAL COMMITTEE E]
Forms provided by Texas Ethics Commission www.ethics.state.tx.US Revised 1/1/2021
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)
A' 11lsdil
NICKNAME LAST
SUFFIX (SR., JR., III, etc.)
�e W�r�
4
TELEPHONE NUMBER
AREA CODE PHONE NUMBER
EXTENSION
OF CANDIDATE
!M
(PLEASE TYPE OR PRIM)
5
ADDRESS OF CANDIDATE
STREET/ PO BOX; APT /SUITE #;
CITY;
STATE; ZIP CODE
(PLEASE TYPE OR PRINT)
-
6
OFFICE SOUGHT
BY CANDIDATE
(PLEASE TYPE OR PRINT)
`,
�
CUv� e: m
1
S
7
NAME OF COMMITTEE
(PLEASE TYPE OR PRINT)
8
NAME OF CAMPAIGN
TREASURER
TITLE (Dr., Mr., Ms., etc.) FIRST
S Wl
MI
(PLEASE TYPE OR PRINT)
-- —
— ---- ------ - - - ----------------------------------
N—I—CK—N—AME LAST
} j w a
6 UFFIX (SR., JR., III, etc.)
i%
GO TO P GE 2
Forms provided by Texas Ethics Commission www.ethics.state.tx.US Revised 1/1/2021
There are basic principles of decency, honesty, and fairplay 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.
TIEREFORE:
(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 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) 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 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) I will immediately and publicly repudiate methods and tactics that may come from others that 1 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 a political
committee, hereby voluntarily endorse, subscribe to, and solemnly pledge myself to conduct the campaign in accordance
with the above principles and practices.
J Signature
i9 J")laI
Date
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 1/1/2021