HomeMy WebLinkAboutApplication for Place on the Ballot-05.07.2016-Gonzalez,TommyAW2-15,7/2011
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.
INDI�CE TERM
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E�Z FULL 0 UNEXPIRED
FULL NAME (First, Middle, Last)PRINT
NAME AS YOU WANT IT TO APPEAR ON THE BALLOT
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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.)
CITYSTATE
ZIP
CITY
STATE
ZIP
CTC o'-dICA-z", V.,J
EMAIL ADDRESS (Optional)
OCCUPATION (Do not leave blank)
DATE OF BIRTH
VOTER REGISTRATION VUID NUMBER
(if applicable)
"
TELEPHONE NUMBER (Include area code) (Optional)
Length of Continuous Residence as of Date Application Swom
OFFICE:
IN STATE IN CITY IN DISTRICYOR PRECINCT'
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HOME-
yr(s) yr(s) yr(s)
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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 by this nickname for at least three years prior to this election.
Before me, the undersigned authority, on this day personally�ppeared (name)Q - 1 VOW A who being by me
here and now duly sworn, upon oath says: "I., (name) C'"NG" y let, , of k/ i 1i 1! WSIDY)
County, Texas, being a candidate for the office of C I Al n%01- C-env�pAA,;-, "M swear that I will support and
defend the Constitution and laws of the United States an of the State of Texas. I am a citizen of & United States eligible to hold such office under
the Constitution and laws of this stater 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, Ch ter 573, Government Code.
I further swear that the foregoing statements included in my application are in all things true,;(nd correct."
S1_dNATURE ZF 'CANDIDATE V
Sworn to and subscribed before me at 0, this the, 40 A4, day of Is GOA U CA -If U I A016
SEAL
Signdtfficer aditi4ening oath' Title of OI icer admipistering oat
TO BE COMPLETED BY CITY SECRETARY:
(See Section 1.007) "Y_
Date R�eci ed I Signature of City.tary
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