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Form #2201 Rev. 06/2003 <br />Submit to: <br />SECRETARY OF STATE <br />Statutory Documents Section <br />P O Box 13550 <br />Austin, TX 78711 -3550 <br />512- 463 -5705 <br />512 -475 -2815 - Fax <br />Filing Fee: None <br />• <br />STATEMENT OF OFFICER FOR <br />OFFICERS NOT APPOINTED BY <br />THE GOVERNOR <br />This space reserved for office use <br />Statement <br />1, Sherman Moore , 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 me God. <br />Position to Which Elected/Appointed: Zonin Board of Adjustment Alternate 2 <br />City and/or County: LaPorte, TX Harris Coon <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 />Form 2201 <br />