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Form 82201 Rev, 10/2011 <br />Submit to: <br />SECRETARY OF STATE <br />Government Filings Section <br />P 0 Box 12887 <br />Austin, TX 78711-2887 <br />512-463-6334 <br />512-463-5569 - Fax <br />Filing Fee: None <br />r" 0 <br />C� "PS <br />CO <br />STATEINMINT OF OFFICER <br />Statement <br />This space reserved for office <br />use <br />13 Mark Follis — , do solemnly swear (or affirm) that I have not <br />directly or indirectly paid, offered, promised to pay, contributed, or promised to contribute any money or <br />thing of value, or promised any public office or employment for the giving or withholding of a vote at the <br />election at which I was elected or as a reward to secure my appointment or confirmation, whichever the <br />case may be, so help i-ne God. <br />Position to Which Elected/Appointed: Building Codes Appeals Board, Position 7 <br />City and/or County: <br />La Porte, Harris <br />Execution <br />Under penalties of perjury, I declare that I have read the foregoing statement and that the facts stated therein <br />are true, <br />Date: <br />Signature of Officer <br />Revised 10/2011 <br />Fonn 2201 2 <br />