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Sarah Dietz2-So Prescribed by Secretary of State Section 141.032, Chapters 143 and 144, Texas Election Code; Section MOSS, Texas Education Code 07/2025 APPLICATION FOR A PLACE ON THE BALLOT FOR A SPECIAL 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 ELam. Le _ _ SPECIAL 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.) I INDICATE TERM ! ❑FULL UNEXPIRED FULL NAME (First, Middle, Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT' ,SAP2A 4 W N D t-t"2 S� Ff 16Tz PERMANENT RESIDENCE ADDRESS (Do not include a P.O. Box or Rural Route. PUBLIC MAILING ADDRESS (Address for which you receive campaign related If you do not have a residence address, describe location of residence.) correspondence, if available.) asap ���y� Lc..� � ►�� t��M � Ci7Y - - - STATE j ZiP - -- - CRY G��IeT — 17C PUBLIC EMAIL ADDRESS (Address for which you OCCUPATION (Do not leave blank) receive campaign related emalls, if available.) ,r1 ` - Y�,11` SACA b 1)1 �Z 2-F f-A i--M � Q YYYtI , f' m4A {�(i TELEPHONE CONTACT STATE ZIP DATE OF BIRTH VOTER REGISTRATION VUID NUMBERz (optionail Home: Office: Cell: C�Q b -a ` ` ^ b - e FELONY CONVICTION STATUS (You MUST check one) LENGTH OF CONTINUOUS RESIDENCE AS OF DATE THIS APPLICATION WAS SWORN I have not been finally convicted of a felony. IN THE STATE OF TEXAS iN TERRITORY/DISTRICT/PRECINCT FROM 1 have been finally convicted of a felony, but I have been WHICH THE OFFICE SOUGHT IS ELECTED pardoned or otherwise released from the resulting 2—d year(s) year(s) disabilities of that felony conviction and i have provided proof of this fact with the submission of this application 3 month(s) month(s) This Box Must ONLY be Completed by Candidates for School District Board of Trustees Check the Box Below: I am aware that I am not eligible to serve as a trustee of an independent school district if I am required to register as a sex offender under Chapter 62, Code of Criminal Procedure. '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 per§onally appeared (name of candidate) . lA Di P tz ; who being by me here and now duly sworn, upon oath s `I, (name of and' ate) of 116AaJ IA County, Texas, being a candidate for the office of swear that I will support and defend the Cons itutio� n 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 pro se formation on the application regarding my possible felony conviction status constitutes a Class B misdemeanor. I further sw t the foreis i cluded in my application are in all things true and correct.' x T CA MATE - — Sworn to and subscribed before me this the y' day . --) 6 . by _CQcrVh (day) (month) (year) (name of candidate) Officer Authorized to Administer Title aT Officer)kuthorizeii to Administer Oath _, Printed Name of Officer Authorized to Administ th TO BE COWtETED BY FILING OFFICER: THIS APPLICATION IS ACCOMPANIED Bl CASH M CHECK El MONEY ORDER l CASHIERS CHECK OR 0 PETITION IN This document andS6'C> filing fee or a nominating petition of pag / o a,p� oa , Qa , (See Section 1.007) Date Received _ Date Accepted D F1UNqWJE§4Vpip)1cable) ID BY: lNdtf@ F! EOSS Oflf31110ZS us Verified of Filing Officer or Designee CODE OF FAIR CA iiiPAiGb 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 anytime. .Subscription to the Code of Fair Campaign Practices is voluntary. 1 ACCOUNT NUMBER 2 TYPE OF FILER (Ethics Commission Filers) CANDIDATE !f filing as a candidate, complete boxes 3 - 6, Own read and sign page 2. 3 NAME OF CANDIDATE (PLEASE TYPE OR PRINT) 4 TELEPHONE NUMBER OF CANDIDATE (PLEASE TYPE OR PRINT) 5 ADDRESS OF CANDIDATE (PLEASE TYPEORPRINT) 6 OFFICE SOUGHT BY CANDIDATE (PLEASE TYPE OR PRINT) NAME OF COMMITTEE (PLEASE TYPE OR PRINT) $ NAME OF CAMPAIGN TREASURER (PLEASE TYPE OR PRINT) FORM CFCP COVER SHEET OFFICE USE ONLY Date Received Date Hand-0ellvered or Postmarked Date Processed POLITICAL COMMITTEE 11 N filing for a political committee, complete boxes 7 and 8, then read and sign'page 2. TITLE (Dr., Mr., Me., etc.) FIRST ------------------ -------- NICKNAME LAST AREA CODE PHONE NUMBER STREET I PO 13OX; APT I SUITE t CITY; 252q MfUl t't16 (!N TITLE (Dr., Mr., Ms., eta) NICKNAME LAST FIRSV f eSTT � "� / D 1E� __)1___z1_ GO TO PAGE 2 MI L- ----------- SUFFIX (SR-, JR., III, etc.) EXTENSION STATE. 2112 CODE a0E07Z7. T i MI b• SUFFIX (SR., JR-,111, 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 ofdecency, honesty, and fairplay that everycandidate andpolitical committee in this state has amoral obligation to observe and uphold, in orderthat, after vigorously contested but fairly conducted campaign our citizens may exercise their constitutional rights to a free and untrammeled choice and the will ofthe MY and clearly expressed on the issues. people maybe rr.fa�r: (1) I will conduct the campaign openly and Publicly and limit attacks on m Opponent's record and stated positions on issues. Y opponent to legitimate challenges to m (2) I will not use orpeimit the use ofchwacter defamation, whispering campaigns, libel, slander, or scurrilous attack 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 mi srepresents, distorts, ar otherwise falsifies the facts, nor will I use malicious orunfounded 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 ham_ or prevents�the full and free expression ofthe will ofthe voters, including any activity aimed at intimidating voters uraging them from voting. (6) 1 will defend and uphold the right ofevery qualified voter to full and and will not engage in any activity aimed at intimidatingvoters or discouraging equal Participation hmfin the electoral process, uraging 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 goveming elections. the undersigned, candidate for election to public office in the State of Texas or campaign treasurer of apolitical ,ommittee, hereby voluntarily endorse, subscribe to, and solemnlypledge myself to conduct the campaign in accordance vith the above principles and practices. Sim Date orms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 1/1/2021 APPOINTMENT OF A CAMPAIGN TREASURER BY A CANDIDATE See CTA Instruction Guide for detailed instructions. 2 CANDIDATE M /MR FIRST MI NAME �IA-Q n n 1 L, ' 3 CANDIDATE MAILING ADDRESS 4 CANDIDATE PHONE 5 OFFICE HELD (if any) 6 OFFICE SOUGHT (If (mown) 7 CAMPAIGN TREASURER NAME 8 CAMPAIGN TREASURER STREET ADDRESS (residence or business) 9 CAMPAIGN' TREASURER PHONE 10 CANDIDATE SIGNATURE NICKNAME LAST SUFFIX D ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE Mf,, -V I UL7t,-- l 15 U H F 12TZ 11 X .-I I? I S4 AREA CODE PHONE NUMBER EXTENSION (Z1D) —, JGL — ©2-1 FORM CTA PG 1 1 Total pages filed: OFFICE USE ONLY Filer ID # Date Received — �1 O� Qate Heed-dellvered or Pcstrnadced Receipt# j nmw-n s Date Processed Date Imaged ,0LA e _ ' V MS/M R FIRST MI NICKNAME LAST STREETADDRESS; APT/SUITE#. CITY; STATE; 1A 1E, LV I l_l_7�-- LAN -E- C "1a ,;1'� i �Z X �i I AREA CODE PHONE NUMBER EXTENSION 6 21 S� SUFFIX ZIP CODE I am aware of the Nepotism Law, Chapter 573 of the Texas Government Code. i 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 a o izations. _� a-; Sign reCandid Date Signed Fors provided by Texas Ethics Commission GO TO PAGE 2 www.ethics.state.tx.US Revised 1/1/2026 CANDIDATE MODIFIED REPORTING DECLARATION ill CANDIDATE NAME 12 MODIFIED REPORTING DECLARATION COMPLETE THIS SECTION ONLY IF YOU ARE CHOOSING MODIFIED REPORTING FORM CTA PG 2 I •• This declaration must be filed no later than the 30th day before the first election to which the declaration applies. •• The modified reporting option is valid for one election cycle only. we (An election cycle includes a primary election, a general election, and any related runofrs.) • Candidates for the office of state chair of a political party may NOT choose modified reporting. •- I do not intend to accept more than $1,140 in political contributions or make more than $1,140 in political expenditures (excluding filing fees) in connection with any future election within the election cycle. 1 understand that if either one of those limits is exceeded, I will be required to file pre -election reports and, if necessary, a runoff report. Year Ofelection(s) orelection cycle to Signature of Candidate which declaration applies This appointment is effective on the date it Is filed with the appropriate filing authority. TEC Filers may send this form to the TEC electronically at treasa oint ethicS.state_.tx.us or mail to Texas Ethics Commission P.O. Box 12070 Austin, TX 78711-2070 Non-TEC Filers must file this for— with the local filing authority DO NOT SEND TO TEC For more information about where to file go to: hftps://www.ethics.state.bc.us/rilinginfo/QuickFileAReport.php Forms provided by Texas Ethics Commission WWw.ethics.state.tx.us Revised 1/1/2026