The republic of Texas

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1 Please Read and Follow Instructions 1. How to mark your Ballot When Voting: Mark an X on the line next to your candidate(s) choice for whom you are voting. (Example: Joe Blow ). A vote for yourself is considered a valid vote. ----OR---- Write in your own name or a candidate s name of your choice in the Write-In Section. X 2. Write-in Candidates: Write in the name of a candidate of your choice below the Write-In Candidate area. You may write in your own name, if you wish, for any position on the Ballot. Download, fill out and attach the Write-In Candidate Information form and attach it to your Ballot. You must write your Ballot number on the Write-In Candidate Information form. Please read the Candidate Eligibility document in the Election section of the above website address. The deadline date for transmitting the Write-In Candidate s required documents to the Secretary of State, Texas Republic is September 09, National Offices: (not applicable this election) All eligible voters may vote for only ONE president and ONE vice president or write-in a candidate for each office. 4. District Offices: All eligible voters who are domiciled in the jurisdictional republic of Texas counties for the district where they are domiciled may vote for the Senate Seat candidate and Judicial District Office Seat candidate or you may write-in a candidate. Read above instructions for write-in candidates. 5. County Offices: All eligible voters who are domiciled in that named county may vote for House Representative(s), or county positions as listed or may write-in a candidate s name or if more than one position is required you may write in one candidate s name for each position. 6. CASTING YOUR BALLOT: When you have down loaded and completed your Ballot and Write-In Candidate form(s), if applicable, send your Ballot plus your Write-In Candidate Information form(s) via United States Postal Service to Secretary of State, Republic of Texas, US Post Office Box 280, Iola, Texas [77861] WARNING!!! Failure to follow instructions may disqualify your vote. NATIONAL OFFICES (not applicable this election) Page 1! of 5!

2 EXECUTIVE DEPARTMENT OFFICES President of the Texas Republic Vice-President of the Texas Republic DISTRICT OFFICES (not applicable this election) SENATE DISTRICT NO. 0? OFFICE Senator JUDICIAL DISTRICT NO. 5 OFFICES Clerk of the District Court #5 Houston, Nacogdoches, and Rusk Counties Page 2! of 5!

3 COUNTY OFFICES HOUSE SEAT COUNTY OFFICES Houston County House Representative Nacogdoches County House Representative Rusk County House Representative Barry Eugene Brooks HOUSTON COUNTY OFFICES: NACOGDOCHES COUNTY OFFICES: Page 3! of 5!

4 RUSK COUNTY OFFICES: SUBMIT THIS PAGE WITH YOUR BALLOT WHEN VOTING! This form is to ensure voter eligibility information only and will NOT be filed with your Ballot. Mail this form with your marked Voting Ballot to: Billy D. Ford, Secretary of State, Texas Republic P. O. Box 280 Iola, Texas [77861] Full Name: PLEASE TYPE OR PRINT LEGIBLY Physical Address: City / County: Home Phone: Page 4! of 5!

5 Cell Phone: Age / Birth Year: Length of time domiciled in County (mos./years): _ PLEASE SIGN BELOW PRIOR TO MAILING YOUR VOTING BALLOT FORM! VOTER'S SIGNATURE: VOTER'S PRINTED NAME: DATE SIGNED: Page 5! of 5!

The republic of Texas

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