17-9434 Combination Form (186) Hart Graphics - Austin Section 63.

002 If the voter is unable lo sign his name, the Election Official shall enter his name on the signature roster and shall make a notation of whether the voter is unable to sign because of physical disability, blindness or illiteracy. Pcl. No.
(Niim. de Pel.I

COMBINATION F O R M ~

Poll List, Signature Roster, Affidavits

Juradas)
Q Q Typeofeleclion<LDn^rmatoTl,

Authorily conducting election (Auloridad que adminislra hi eleccion)

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Pet. No.

Authority conducting election

33
Date

The Woodlands R.U.D

Type of Election

17-9318 Statement of Compensation and Oaths (Revised 1/92) Prescribed by Secretary of State swear (or affirm) that I w i l l not in any manner request or seek to persuade or induce any voter Section 32.094,62.003 and 64.034, V.T.C.A., Election Code 'o vote for or against any candidate or measure to be voted on, and that I w i l l faithfully perform m y duty as an officer o f the election and guard the purity o f the election." " I swear (or affirm) that I w i l l not suggest, by w o r d , sign or gesture, h o w the voter should vote: I w i l l confine m y assistance to answering the voter's questions, to stating the propositions on the ballot, and to naming candidates and, i f l i s t e d , their p o l i t i c a l parties: and I w i l l prepare the voter's b a l l o t as the voter d i r e c t s . "

STATEMENT OF COMPENSATION
nw.^ r \C Name of Election Offical

5/1/93
Hours worked From

Directors
Hours worked To Total

Address

Social Security Number

Signature

9700 Grogan's M i l l Road The Woodlands, TX 77380

5:00aii . 8:00an 4/12 - 4/27 7:00am

i i s M '^'^^y^r /=-

36 12 12

7: OOpi

3
4

Nancy Prinieaux, E a r l y Voting 1 Clerk Nancy Primeaiax, P r e s i d i n g 2 Judge Kimberly K. T u n n e l l , A l t e r n a t e Judge

9700 Grogan's M i l l Road The Woodlands, TX 77380

7:00am 7:00pn 0

5 6 7 8 9 10 11 12
Name of Person/Persons who Delivered Election Supplies

1 2
Amount of Compensation lo be allocated to each person who delivered supplies >

Other Expenses (describe) > I state that the above is a true and correct statement of the names, addresses and hours served of all the election officials conducting the above named election and of the other expenses incurred in this election.

Total

*To be filled in by the authorily conducting election unless authority instructs presiding judge to complete

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COMBINATION FORM
(LISTAS COMBINADAS

17-9434 Combination Form (186) Hart Forms & Services - Austin Section 63.002 I f the voter is unable to sign his name, the Election OfTicial shall enter his name on the signature roster and shall make a notation of whether the voter is unable to sign because of physical disability, blindness or illiteracy. Pet. No.
("Num. * Pel.)

de los Volantes y sus firmas, y Declaraciones Juradas) Type of election

(Tipode eleccion)

Poll List, Signature Roster, Affidavits I3ij[^gc-(;^or

VOTANTE) Address
( Direccion )

Aulhorily conducling eleclion

(Auloridad que adminislra la eteccionj

Board of D i r e c t o r s
(Check one if Applicable)

Date of election

Page.
Signature
(Firma)

33

(Fecha

deeleeeionJC^

V O T E R ASSISTANT
Name
(Nombre)

(PERSONA

A YUDANDOLEAL

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