Tim Brown2 -21
Prescribed by Secretary of State
Section 141.031, Chapters 143 and 144, Texas Election Code
1/2017
ALL INFORMATION IS RECIUIRED TO BE PROVIDED UNLESS INDICATED OPTIONAL
APPLICATION FOR A PLACE ON THE Jck f-Z 2 j z GENERAL ELECTION BALLOT
TO: City Secretary/Secretary of Board
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.)
er" 0_occne_/L /LCD
FULL NAME (First, Middle, Last)
PERMANENT REISIDENCE 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.)
CITY �"
5 C r 1 e(T Z..._
PUBLIC EMAIL ADDRESS (If available)
((INDICATE TERM
Li, &ULL
❑UNEXPIRED
PRINT NAME AS YOU WANT IT TO APPEAR ON THE
PUBLIC MAILING ADDRESS (Campaign mailing address, if available.)
STATE ZIP CITY STATE ZIP
T')C ? 1 S C'A e-rz'Z TIC 7c
OCCUPATION (Do not leave blank) DATE OF BIRTH VOTER REGISTRATION VUID
NUMBER (Optional) z
I
'r I �'f $i JGOni S F fZ r M gE A L
TELEPHONE CONTACT INFORMATION (Optional) LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN
Home: IN STATE IN TERRITORY FROM WHICH THE
OFFICE SOUGHT IS ELECTED3
Work:
2— L_year (s) � year (s)
Cell: 3 month(s) month(s)
If using a nickname as part of your name to appear on the ballot, you are also signing and swearing to the following statements: I further swear
that my nickname does not constitute a slogan nor does it indicate a political, economic, social, or religious view or affiliation. I have been
commonly known by this nickname for at least three years prior to this election.
Before me, the undersigned authority, on this day personally appeared (name) '1_10407-141 e, &2owJ who being by me
here and now duly sworn, upon oath says:
"I, (name) / /M OT74- C . -d6J%1 of u Q A l P� County, Texas, being a
candidate for the office of nr Pl, cE 7, swear that I will support and defend the Constitution and laws
of the United States and of the State of Texas. I am a citizen of the United States eligible to hold such office under the constitution and laws of
this state. I have not been finally convicted of a felony for which I have not been pardoned or had my full rights of citizenship restored by other
official action. I have not been determined by a final judgment of a court exercising probate jurisdiction to be totally mentally incapacitated or
partially mentally incapacitated without the right to vote. I am aware of the nepotism law, Chapter 573,,Government Code.
I further swear that the foregoing statements included in my application are in all things a
3 JC
Sworn to and subscribed before meat this the
/ SIMTU
day of
Signature of Officer Administering Oath t Title of Officer A'dminl
TO BE COMPLETED BY CITY SECRETARY OR SEC TRY f BOARD: .
(See Section 1.007) r 2�
Date Received
Voter Registration Status Verified
rrect. "
�.
Expires 01 -02 -2022
Notary ID 1$FF*5140
�p
CJtl�71�
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 / FIRST MI
OFFICE USE ONLY
NAME
Filer ID #
�,
/ �M0 T-74
-- - - - - --
NICKNAME LAST SUFFIX
Date Received
�M 'F�OGti
/]DI
3 CANDIDATE
ADDRESS /PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE
MAILING
q
ADDRESS
Date Hand - delivered or Postmarked
Receipt# Amount$
4 CANDIDATE
AREA CODE PHONE NUMBER EXTENSION
PHONE
Date Processed
Date Imaged
5 OFFICE
HELD
(if any)
I /i� /�
s t— f la/U 40,1-
6 OFFICE
I
SOUGHT
(if known)
'5A ✓Y!
7 CAMPAIGN
MS /MRS /MR FIRST MI NICKNAME
LAST SUFFIX
TREASURER
NAME
lc— �,14
tBrZ.-P
f
8 CAMPAIGN
STREETADDRESS; APT / SUITE #; CITY;
STATE; ZIP CODE
TREASURER
STREET
ADDRESS
(residence or business)
9 CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
S�
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 rest ' ns in title 15 of the Election Code on contributions
from corpora " abor organizations.
/)1
ign re of Candidate
4)
Date Signed
GO TO PAGE 2
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 4/2!2021
CODE OF FAIR CAMPAIGN FORM CFCP
PRACTICES ICES 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 appointment
form. Candidates or political committees that already have a
current campaign treasurer appointment on file as of September 1,
1997, may subscribe to thee & at 'any time. Date Hand - delivered °` Postmarked
Date Processed
Subscription to the Code of Fair Campaign Pract �& is voluntary.
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) i 6� r 0-
------------------------'[-------
NICKNAME LAST SUFFIX (SR., JR., III, etc.)
-1-1iv( (Frei '_% /1
4 TELEPHONE NUMBER AREA CODE PHONE NUMBER EXTENSION
OF CANDIDATE
(PLEASE TYPE OR PRINT)
rJ ADDRESS OF CANDIDATE STREET /PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE
(PLEASE TYPE OR PRINT)
g OFFICE SOUGHT
BY CANDIDATE (/,J/ �jLj A
(PLEASE TYPE OR PRINT) �r�"'v' `1 " /
7 NAME OF COMMITTEE
(PLEASE TYPE OR PRINT)
8 NAME OF CAMPAIGN TITLE (Dr., Mr., Ms., etc.) FIRST MI
TREASURER
�
L
(PLEASE TYPE OR PRINT) -------- - - - - -- - - - - - --
------------------------
NICKNAME LAST SUFFIX (SR., JR., 111, etc.)
GO TO PAGE 2
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 111/2021
CODE OF FAIR CAMPAIGN PRACTICES
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 of the people maybe
fully and clearly expressed on the issues.
(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 pemut 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 d 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 a political
committee, hereby voluntarily endorse, subscribe to, and solemnly pledge myself to conduct the campaign in accordance
with the above principles and practices.
01/ e i y 1?,o2--1
Date
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 1/1/2021