Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 DECLARATION OF SPEAKER CANDIDACY FORM 1 MS / MRS / MR 2 SPK-DEC Total pages filed: Acct. # OFFICE USE ONLY ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ APT / SUITE #; ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ADDRESS / PO BOX; ○ LAST ○ NICKNAME SUFFIX CITY; STATE; SPEAKER CANDIDATE RESIDENCE OR BUSINESS STREET ADDRESS ○ 3 MI ○ SPEAKER CANDIDATE NAME FIRST 1-800-325-8506 Date Received ZIP CODE HD/PM Date Processed 4 SPEAKER CANDIDATE PHONE AREA CODE ( PHONE NUMBER ) EXTENSION Date Imaged 5 LEGISLATIVE SESSION TO WHICH THIS DECLARATION APPLIES 6 SPEAKER CANDIDATE SIGNATURE I am aware that this declaration of speaker candidacy terminates on the earlier of (1) the date I file a written statement with the Texas Ethics Commission stating that I have terminated my speaker candidacy or (2) the date a speaker is elected for the legislative session in connection with which I have filed this declaration. Signature of Speaker Candidate Printed on recycled paper Date Signed Revised 11/21/2003 American LegalNet, Inc. www.USCourtForms.com