HomeMy WebLinkAboutApplication for Place on Ballot 5.7.2016-Fought, SteveAW2-15,7/2011
Prescribed by Secretary of State
Sections 141.031, 143.004, 143.006, Texas Election Code
All information is required to be provided unless indicated as optional.
APPLICATION FOR A PLACE ON THE CITY OF GENERAL ELECTION BALLOT
TO: City Secretary
I request that my name be placed on the above-named official ballot as a candidate for the office indicated below.
OFFICE SOUGHT Include any place number or other distinguishing number, if any.
INDICATE TERM
-X—e-
FULL UNEXPIRED
FULL NAME {First, Middle, Last)
PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT
PERMANENT RESIDENCE ADDRESS (Street address and apartment
MAILING ADDRESS (If different from residence address)
number. If none, describe location of residence. Do not include P.O.
Box or Rural Rt.)
CITY
STATE
ZIP
CITY
STATE
ZIP
76;�
,3 C��,3-5
EMAIL ADDRESS (Optional)
OCCUPATION (Do not leave blank)
DATE OF BIRTH
VOTER REGISTRATION VUID NUMBER
--
Z� <''%P!
(if applicable)
TELEPHONE NUMBER (Include area code) (Optional)
Length of Continuous Residence as of Date Application Sworn
GrOFFICE:
IN STATE IN CITY IN DISTR�CT OR PRECINCT'
HOME:
yr(S) yr(S) yr(s)
mos MOS MOS
If using a nickname as part of your name to appear on the ballot you are also signing and swearing to the following statements: I further
swear that my nickname does not constitute a slogan nor does it indicate a political, economic, social, or religious view or affiliation. I have
been commonly known !?I this nickname for at least three years prior to this election.
Before me, the undersigned authority, on this day personally appeared (name) S;; FFWX) 1"3- who being by me
here and now duly sworn, upon oath says: "l, (name) of 1- -,J
County, Texas, being a candidate for the office of 71V swear that I will support and
defend the Constitution and laws of the United States and of the State of Texas. I am a citizen of the United States eligible to hold such office under
the Constitution and laws of this state. I have not been finally convicted of a felony for which I have not been pardoned or had my full rights of
citizenship restored by other official action. I have not been determined by a final judgment of a court exercising probate jurisdiction to be totally
mentally incapacitated or partially mentally incapacitated without the right to vote. I am aware of the nepotism law, Chapter 573, Government Code.
I further swear that the foregoing statements included in my application are in all things true and correct"
770 a- ;
SIGNATURE OF CANDIDATE
Sworn, to and subscribed before me at Ci k,�A A 4.1 1 this the day of 0-4-N LL Q -r
SEAL
Signature of Office inistering oath2 Title oLgicer administering oath
TO BE COMPLETED BY CITY SECRETARY:
(See Section 1,007) t Q LR --A\aQ QIA
Date geceived Signature Secfetary