AMENDMENT: APPoINTMENT oF ACATPAIGN TREASURER BYA GANDIDATE

1 CANDIOATENAME

( rt3 Iot l p.C.. fi.d:

S.a AgfA lnrttuctloi Guld. for d.t lLd ln.trucllon..U.. thl. ,orm tor chrnrE to axLtlne lnio.tn gon orrr. Do not provldo lntortn Uon pr.yloualy dbclo!.d.

OFFICE UAE OXLYVte{ok E,'* H a['." I JUL 2

BY:D.r. lt$.rd.lhdld q P6urd.n

5 CAI{DIDATEIIAILINGADDRESS 5b5l '/ii*x l*.

ilorrto ^

7x zro,t

9t tE zP coDEADORESS /PO9ON ^PrlSUltEt

CITYj

6 CAI.IDIOATEPHOI{E

7 OFFICE HELD

a OFFICESOUGHT

hoo I BoarJ fot;lio* 7E CAMPAIGN

TREAST.,RERtIAME

t^al

l'lehertFIRgT NtcxNAllE

Ms J as e.e-

Cre=.ert f/a.n Dr,

Hous*,on

S'TREEI ADRESS

t155APr/sUlTEt CrYi AIATE ZP @DE

-fx 7't oltIO CAMPAIGN

TREASURERSTREETADORESS

(Edd.nc! or biJ.lrr.a)

flt3) 1//#- 5qlrlIt CAMPAGN

TREASiI'RERPHONE

I am awar€ ofth6 Nopotism Law Chaptor 573 ofthe Texas Govemment Code.

I am awar€ of my r€sponsibility to fil€ timely reports as requlrod by titl€ 15 ofthe Election Code.

I am awar6 of tho rostric-tions ln titl6 15 of the Election Code on contributlons

Slgn.hjrs of Candldato Slgned

sftom labor ons.

12 CANDIDATESIGtIATURE

GO TO PAGE 2

Fodrrr prwldod by Tax.. Ethlc. Co.nml..lon wv,*.ethlca.ttrto.tx.ua RB.tk€/l 1tzl2o21

ronuACTApol

2 FL€R tO I

. CATIDIDATEI{AME

2021

<qot 2bl'1Ll.5DNEw I

r.E\,1, I

5c

r€tv I EXTEXStoa.t

ALL INFORMATION IS REQUIRED TO BE PROVIDED UNLESS INDICATED OPTIONAL APPLICATION FOR A PLACE ON THE 'I<

TO: City Secretary/Secretary of Board

2-21 Prescribed by Secretary of State

Section 141.031, Chapters 143 and 144, Texas Election Code 1/2017

ENERAL ELECTION BALLOT

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

13 o°'rd Vo-s-t +t; r1 1 �LL I DuNEXPIRED

FULL NAME (First, Middle, Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT1

Or. V,·c+o� PERMANENT RESIDENCE ADDRESS (Do not include a P.O. Box or Rural PUBLIC MAILING ADDRESS (Campaign mailing address, if available.) Route. If you do not have a residence address, describe the address at which you receive personal mail and location of residence.)

S(oSI TR,-wA'-( L"'­P/-ous-1-o tJ TX 7? tJLf I

c� Vt s 1-rJ NPUBLIC EMAIL ADDRESS (If available)

STATE

,x ZIP CITY

71 OL/ IOCCUPATION (Do not leave blank) DATE OF BIRTH

JZ.e.-+,r�d (A'f",v, CT)-'J-'i �o.fEi-.5,.s or--

STATE ZIP

VOTER REGISTRATION VUID

NUMBER (Optional) 2

TELEPHONE CONTACT INFORMATION (Optional) LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN Home: IN STATE

Work: /...3._year (s)

Cell: __ month(s)

IN TERRITORY FROM WHICH THE OFFICE SOUGHT IS ELECTED3

65" year (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) l) r. Vi c....+o, µe I b lr t , who being by mehere and now duly sworn, upon oath says:

"I, (name) V / C +-0'(""' � � � e. YT , of ;Jg, V'Y' LS County, Texas, being acandidate for the office of ;5 c. e o '3 o 0.. ,,-J , 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 S73, Government Code.

I further swear that the foregoing statements included in my application are in all

SECRE (See Section 1.007)

Oat Voter Registration Status Verified

X HOLLY A REICHERT NOTARY PUBLIC

• STAT� TEXASMY COMM. EXP. 01/28/ 022NOTARY ID 673424-2

CODE OF FAIR CAMPAIGNPRAGTICES

FORM CFGPCoven Sxeer

OFFICE USE ONLY

RECEIVEDJUL I '1t21

Pursuant to chapter 258 of the Election Code, every candidate andpolitical committee is encouraged to subscribe to the Code of FairCampaign Practices. The Code may be filed with the proper filingauthority upon submission of a campaign heasurer appointrnentform. Candidates or political committees that already have acurretrt campaign treasurer appointrnent on file as of September 1,1997, may subscribe to the code at any time.

Subsciption to the Code of Fair Campaign practices is voluntary.

POLITICAL COMMITTEE

I AccoUNT NUMBER(Ehics Commission Fllers)

lf fling as a candidale, complete boxos g - 6,then Bad and sun pago 2.

lf frling bt d political cnmmifteo, comptoteboxes 7 and 8, then Ead and sign page 2.

3 NAME oF CANDTDATE(Pir liE IYPE OR PFjN'

qJFFx(s&,JR.. nl,.b.)

Abb.fs

NICXNAME

Dr. V; .r, n

TITLE (Oi, Mr., M..,6lc )

AREA COOE PHONE NIMBER

(910 )

f:XTENSION

5 ADDRESS oF CAND|DATE(PLEASE TYPE OR PR]NT)

SIREET/POBOX APTI SIJIIE I CTTY:

s65t -[?iwa-y h. [l"urlouzPcooE

Tr .l70ll I

6 oFFrcE SOUGHTBY CANDIDATE(PLE]1SE TYPE OR PFJNT) 5.[.ol B oo.,.J

7 NAME OF COMMITTEE

{PLE SE TYPE OR PRINT}

8 NAME OF CAMPAIGNTREASURER(PIEASE TYPE OR PRNT)

SUFFX (SR. JR.,lll,.t .)

rhNICKNAME

Ms. JoYce-IIILE (Dr, M,-, M.., .tc.)

GO TO PAGE 2

Forms providsd by lexas Ethics Commission Revised 11112021

2 TYPE oF ettea /

"oro'oor= /

4 TELEPHONE NUMBEROF CANDIDATE

P(.EASE TYPE OR PRIMD 26t.3+5oSTATE:

www.ethics.stats_fi .us

CODE OF FAIR CAMPAIGN PRACTICES

There are basic principles ofdecency, honesty, and fair play that every candidate and political committee in this state

bas amoral obligation to observe andwhold, in order that, aftervigorously contestedbut fairly conducted campaigns,

oru citizens may exercise their constitutional rights to a free and untrammeled choice and the will ofthe people may be

frrlly and clearly expressed otrthe issues.

THEREFORE:

(l) I will conduct the carnpaip openly and publicly and limit attacks on my opponent to legitirnate challenges to my

opponent's record and stated positions on issues.

(2) I will not use or permit the use ofcbaracter defamatioq whispering campaigs, 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 rnaterial ofany sort that misrepresents, distorts, or otherwise falsifies the facts, nor will Iuse malicious or unfounded accusations that aim at oeating or exploiting doubts, withoul justification, as to the

penonal inlegrity or patriotism ofmy opponent.

(5) I \irill not undertake or condone any dishonest or unethucal practice that tends to corrupt or undermine or:r system

offtee elections or tlat hampers or prevents the firll and free expression ofthe will ofthe voters, including any

activity aimed at intimidating voters or discouraging than Aom voting.

(6) I will defend and uphold the right ofevery qualified voter to full and equal participation in the electoral process,

and will not engage in any activity aimed at intimidating voteB or discouaging thern from voting.

(7) I will immediately and publicly repudiate methods and tactics that may come ftom others that I have pledged not

to tse or condone. I shall take finn action against any subordinate who violates any provision ofthis code or the

laws governing elections.

I, the undersigred, candidate for election to public office in the State ofTexas or campaign treasurer ofa political

committee, hereby vohmtarily endorse, subscribe to, and solemnly pledge mlselfto conduct the carnpaign in accordaoce

with the above principles and practices.

7 o&lSignatue Date

Forms provided by Texas Ethics Commission wY/w.ethics.slats.U.us Re\tlsed 11112021