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<br />PLEASE lYPE OR PRINT lEGIBLY <br /> <br />PROVIDE AIL REQUESTED INFORMATION <br /> <br />STATEMENT OF ELECTED/APPOINTED <br />OFFICER <br /> <br />(Pursu.ant to Tex. Canst. art. XVI, 11 (b), amended 2001) <br /> <br />I, Pat MlL6.ton . do solemnly swear <br />(or affirm), that I have not directly or indirectly paid, offered, promised to pay, <br />contributed, or promised to contribute any money or thing of value, or promised any <br />public office or employment for the giving or withholding of a vote at the election at <br />which I was elected or as a reward to secure my appointment or confirmation, <br />whichever the case may be, so help me God. <br /> <br />UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING STATEMENT AND <br />THAT THE FAcrs STATED THEREIN ARE TRUE <br /> <br />3(crl!00 <br /> <br />Date <br /> <br />~of~ <br /> <br />Affiant s Signature <br /> <br />PhQ-6.irlQV,/t - La. POI:!.tg. vg.')g.eQJ?m~14.t COfLpoJu1t,t(.'J~ <br />Position to Which Elected/Appointed . <br /> <br />La. PO/t.te. <br />City and/or County <br /> <br />Form No. 2201 <br />