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Form #2201 Rev. 06/2009 This space reserved for office use <br /> Submit to: �Q,C E O\ <br /> SECRETARY OF STATE w p0 ° ` V, <br /> Statutory Documents Section �!, -W •MI6, <br /> P O Box 13550 F � +� 4 <br /> Austin, TX 78711- 3550 <br /> 512 - 463 -5705 <br /> 512- 475 -2815 - Fax STATEMENT OF OFFICER FOR <br /> Filing Fee: None OFFICERS NOT APPOINTED BY <br /> THE GOVERNOR <br /> Statement <br /> I, Dottie Kaminski , 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: Council At- Large, Position B <br /> City and/or County: La Porte, Texas <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. gak Date: 6 �, 6 /7 5t <br /> Signature of Officer <br /> ,c =ZOO L4p. <br /> s <br /> Form 2201 2 <br />