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Form 92201 Rev. 06 /2009 <br />$ p <br />OFFICERS NOT APPOINTED BY <br />THE GOV <br />This space reserved for office use <br />�¢d! <br />I, Hcicn La Cour , 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 witlxl -iolding 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: P'lam and Zoning Commission District 3 <br />City and/or County: La Forte, TX Harris <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: August 2, 2011 <br />Signature of Officer <br />Form 2201 2 <br />