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l±orin 42201 Rev. 06/2009 <br />Submit to: <br />SECRETARY OF STATE <br />Statutory Documents Section <br />P 0 Box 13550 <br />Austin, TX 7871.1-3 50 <br />512-463-5705 <br />512-475--2815 - Fax <br />Filing Fee: None <br />f ist* f t <br />This space reserved for office use <br />1, Mark Follis , do solemnly swear (or affirni) 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 me God. <br />Position to Which Elected/Appointed: Planning and Zoning Commission District 4 <br />City and/or County: LaPorte, TX Harris County <br />4M i A' x s 6 [ 11 1 <br />Under penalties of perjury, I declare that I have read the foregoing statement and that die facts stated therein <br />are true. <br />Date: August 2, 2011 <br />Signature of Officer <br />Form 2201 <br />