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Robert M. Westbrook2-26 Prescribed by Secretary of State Section 141.031, Chanters 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 app APPLICATION FOR A PLACE ON THE rijy 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. FFICE SOUGHT (Include any place number or other distinguishing number, if any.) INDICATE TERM rS C � .�,tU _S .0 L. ob 1=1 Ir 4 U r `n. I x W f / ® FULL � UNEXPIRED NAME (Firs, 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 Route. If PUBLIC MAILING ADDRESS (Optional) (Address for which you receive you do not have a r)4idence addryr describe location of residence.) campaign related correspondence, if available.) CITY STATE ZIP CITY 4 PUBLIC EMAIL ADDRESS (Optional) (Address for OCCUPATION (Do not leave blank) DATE OF BIRTH which you receive campaign related emails, if available.) TELEPHONE CONTACT INFORMATION (Optional) STATE I ZIP VOTER REGISTRATION VUID NUMBER' (Optional) Home: Office: Cell: FELONY CONVICTION STATUS (You MUST check one) LENGTH OF CONTINUOUS RESIDENCE AS OF DATE THIS APPLICATION WAS SWORN 1 have not been finally convicted of a felony. 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 IS ELECTED pardoned or otherwise released from the resulting year(s) years) disabilities of that felony conviction and I have provided month s) month(s) proof of this fact with the submission of this application 3 ( *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 regarding 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) who being by me here and now ly sworn, upon oathsays: n /� "I, (name of candidate) of l 48 11 n - County, Texas, swear that I will support being a candidate for the office of and defend the Constitution and laws of the United States and of the Sta a of Texas. I am a citizen of the United Statd 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 informatJoapri the application regarding my possible felony conviction status constitutes a Class B misdemeanor. I further swear that the foregoing state ents ' cludeA it mx application are in all things true and correct." X SIGNATURE O D Sworn to and subscribed before me this thg-day of - - by to Title of Offic r Authorized to Admihhter Oath TO BE COMPLETED BY FILING OFFICER: THIS APPLICATION IS ACCOMPANIED BY n CASH ❑ CHECKE1 MONEY ORDER ❑ CASHIERS CHECK OR PETITION IN L This document and $_ filing fee or a nominating petition of pages c (See Section 1.007) Date Receive D e Accepted S (namq of candidate) Ig lni� r Oath EDIMONDSON - STATE OF TEXAS ENVANOMeRAID BY: Voter ReRistpation Status Verified CODE OF FAIR CAMPAIGN PRACTICES 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. FORM CFCP COVER SHEET OFFICE USE ONLY Date Received Date Hand -delivered or Postmarked Date Processed 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) M NICKNAME LAST SUFFIX (SR., JR., III, etc.) `1 l 4 TELEPHONE NUMBER AREA CODE PHONE NUMBER EXTENSION OF CANDIDATE (PLEASE TYPE OR PRINT) 1/ 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) 7 NAME OF COMMITTEE (PLEASE TYPE OR PRINT) 8 NAME OF CAMPAIGN TITLE (Dr., Mr., Ms., etc.) FIRST TREASURER (PLEASE TYPE OR PRINT) ��, ------------------------ — ------------------- NICKNAME LAST GO TO PAGE 2 MI --------------------- SUFFIX (SR., JR., III, etc.) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 1/1/2021 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 orderthat, aftervigorously 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 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 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 myselfto conduct the campaign in accordance with the above principles and practices. gnature Date Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 1/1/2021