Paul J. Kendzior2 -26
Prescribed by Secretary of State
Section 141.031, Chapters 143 and 144, Texas Election Code
09/2021
APPLICATION FOR A PLACE ON THE BALLOT FOR A GENERAL ELECTION
FOR A CITY, SCHOOL DISTRICT OR OTHER POLITICAL SUBDIVISION
ALL INFORMATION IS REQUIRED TO BE PROVIDED UNLESS INDICATED AS OPTIONAL' Failure to provide required information may result in rejection of application.
APPLICATION FOR A PLACE ON THE )U*ve-A tl Vh GENERAL ELECTION BALLOT
TO: City Secretary/Secretary of Board (name of election)
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
S'Gktlt2 CA, COuilGr' 19 1`LCG :0,4- 2. _ FULL E] UNEXPIRED
FULL NAME (First, Middle, Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT*
Raj a�.40 b cue njz i v y�
P acJ , Keodz)iar
PERMANENT RESIDENCE ADDRESS (Do not include a P.O. Box or Rural Route. If PUBLIC MAILING ADDRESS (Optional) (Address for which you receive
you do not I?- ayes resiogn a tbe location of residence.) c Pnr If�av-2iable.)
Sc.ke.( fZ
STATE ZIP CITY
Tx 7gtv8 SU�1c�fZ
PUBLIC EMAIL ADDRESS (Optional) (Address for OCCUPATION (Do not leave blank) DATE OF BIRTH
which 4otyourreceive campaign related emails, if available.)
I 7Si6/fz W'di(.G9AA 0i1'64 6e, ".."s /7sJ ti"-
TELEPHONE CONTA& INFORMATION (Optional)
Home:
FELONY CONVICTION STATUS (You MUST check c
D? I have not been finally convicted of a felony.
Office:
STATE ZIP
Tx 7sa ?75
VOTER REGISTRATION VUID
NUMBER2 (Optional)
Cell:
LENGTH OF CONTINUOUS RESIDENCE AS OF DATE THIS APPLICATION WAS SWORN
IN THE STATE OF TEXAS IN TERRITORY /DISTRICT /PRECINCT FROM
I have been finally convicted of a felony, but I have been WHICH THE OFFICE SOUGHT( ELECTED
pardoned or otherwise released from the resulting 2 Years) yearss )
disabilities of that felony conviction and I have provided
proof of this fact with the submission of this application.3 month(s) i 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 or contain a title, 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. Please review sections 52.031, 52.032 and 52.033 of the Texas
Election Code reeardinR the rules for how names may be listed on the official ballot.
Before me, the undersigned authority, on this day personally appeared (name of candidate) � l
being by me here and now duly sworn, upon oath says:
"I, (name of candidate) P.KI '- . of _ C 0t"'L �.
who
County, Texas,
being a candidate for the office of #2 . 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 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 am aware that I must disclose
any prior felony conviction, and if so convicted, must provide proof that I have been pardoned or otherwise released from the resulting disabilities of
any such final felony conviction. I am aware that knowingly providing false information on the epplication warding my possible felony conviction
status constitutes a Class B misdemeanor. I further swear that the foregoing statements i Ii,,,ftd i my-applfccaY ' e in all things true and correct."
SIGNATURE OF CANDIDATE
to ands scribed before me this the /r I Iday of mot` 2-097,. by 1b k) r he 7--i Od
(day) lonth) (y E {� ame of candidate)
we of Officer A thorized to Administer at 4 Printed Name of Officer Authorized to Administer Oath
Title of Officer Authorized Vb Administer Oath J
TO BE COMPLETED BY FILING OFFICER: THIS APPLICATION IS ACCOMPANIED BY T
CASH N CHECK ❑ M N.FY ORDER ED CASHIERS CHECK OR 11 PETITION IN LI
This document and $ UU filing fee or a nominating petition of pages
or Off *&4. EDMONDSON-
Nwigypt
iE iiI'•''
D FILINGO IMoplicable
ZZ- 0 2'(, /ZOZZ— (See Section 1.007)
Date Received Date Accepted Signature of Fili g Officer or
D BY:
Verified
CFCP
UODE 01= 1=AI1m CAlIr11�AIGIV
FORM
COVER SHEET
PRACTICES
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
"eq '�7
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,
p�
1997, may subscribe to the code at any time.
Date Hand-delivered-or Postmarked
Date Processed
Subscription to the Code of Fair Campaign Practices 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
PRINT)
TITLE (Dr.,Mr.,Ms.,etc.) FIRST
MI
(PLEASE TYPE OR
l Nk
��JJ
----------------------------------------------------------------------------
NICKNAME LAST
SUFFIX (SR., JR., III, etc.)
vle" Ix D
4 TELEPHONE NUMBER
AREA CODE PHONE NUMBER
EXTENSION
OF CANDIDATE
(PLEASE TYPE OR PRINT)
I
5 ADDRESS OF CANDIDATE
STREET /PO BOX; APT /SUITE #; CITY;
STATE; ZIP CODE
(PLEASE TYPE DR PRINT)
6 OFFICE SOUGHT
BY CANDIDATE
(PLEASE TYPE OR PRINT)
/d
C Cfr- / �/ Q —y—�
L�r
7 NAME OF COMMITTEE
(PLEASE TYPE OR PRINT)
8 NAME OF CAMPAIGN TITLE (Dr., Mr., Ms., etc.) FIRST
MI
TREASURER r1� �,S
/" 1 a e
(PLEASE TYPE OR PRINT) ----------------------------------------------------------------------------
NICKNAME LASTQ
SUFFIX (SR., JR., III, etc.)
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GO TO PAGE 2
Forms provided by Texas Ethics Commission
wwmethics.state.N. Lis
Revised 1/112021
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.
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) 1 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 orpatriotism ofmy 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 I have pledged not
to use or condone. I shall take firin 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.
zz /2ozz
Signature Date
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 1/1/2021