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<br />PLEASE TYPE OR PRINT LEGIBLY <br />PROVIDE ALL REQUESTED INFORMATION <br /> <br />STATEMENT OF ELECTED/APPOINTED <br />OFFICER <br /> <br />(Pursuant to Tex. Const. art. XVI, *l(b), amended 2001) <br /> <br />I, Gilbert Montemayor, do solemnly swear (or affirm), that I have not directly <br />or indirectly paid, offered, promised to pay, contributed, or promised to contribute any <br />money or thing of value, or promised any public office or employment for the giving or <br />withholding of a vote at the election at which I was elected or as a reward to secure <br />my appointment or confirmation, whichever the case may be, so help me God. <br /> <br />UNDER PENALTIES OF PERJURY, 1 DECLARE THAT 1 HAVE READ THE FOREGOING <br />STATEMENT AND THAT THE FACTS STATED THEREIN ARE TRUE. <br /> <br />lIlt? jlfJ <br />, <br />Date <br /> <br />A~~ <br /> <br />Affiant's Signature r <br /> <br /> <br />)kJ~ J:L ----- <br /> <br />City and/or County <br /> <br />Position to Which Elected/Appointed <br /> <br />Form No. 2201 <br /> <br />t ..,~~.~,~. <br />,.;tt~ <br />~; \'i.~.:j <br />jl..;'1'.....~. <br />.f ....,?:,,:.. <br />t ~. ~. <br /> <br />SHANNON DODSON GREEN <br />MY COMMISSION EXPIRES <br />~ 12, 2013 <br />