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HomeMy WebLinkAboutApplication for a Place on the Ballot-01.25.2018-Pitts,Kevini-21 Prescribed by Secretary of State Section 141.031, Chapters 143 and 144, Texas Election Code ALL INFORMATION IS REQUIRED TO BE PROVIDED UNLESS INDICATED OPTIONAL 1/2017 APPLICATION FOR A PLACE ON THE GENERAL ELECTION BALLOT TO: City Secretary/Secretary of Board 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 Cs` i L + FULL I UNEXPIRED (First, Middle, Last) he(.11 P,` PERMANENT RESIDE ADDRESS (Do not include a P.O. Box or Rural Route. If you do not have a residence address, describe the address at which you receive personal mail and location of residence.) CITY D e to PUBLIC EI STATE I ZIP PRINT AME AS YOU WANT IT TO APPEAR ON THE BALLOT ' Te ll)'1 I S PUBLIC MAILING ADDRE S (Campaign mailing address, if available.) RECEIVED CITY oW7-x 17303 1 Cie© ADDRESS (If available) I OCCUPATION (Do not leave blank) TELEPHONE JAN z 5 2018 STATE ZIP d ov✓n PC 713 OF BIRTH VOTER REGISTRATION VUID NUMBER (Optional) z 1 LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN IN STATE IN TERRITORY FROM WHICH THE OFFICE SOUGHT IS ELECTED _33 year (s) 14 year (s) Cell: 1 � month(s) � � month(s) 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 appeared (name) -yo who being by me here and now duly sworn, upon oath says: l "I, (name) --rwt I k w of �1 [ rll5i� County, Texas, being a candidate for the office of Cao M M -r )Ib f' ► S�0swear 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 thin a and correct." X SIGNATURE OF CANDIDATE Sworn to and subscribed before me at Signature of Ocer dministering Oath4 TO BE COMPLET CITY SECRETAR C (See Section 1.007) Voter Registration Status Verified 0 this the .z 5 day of C- c VN) 11 ur" Title of Offic dministeriniz Oath J �RETAR'[OF 10ARD. ;D Zj a0I F Date Received Signature SEAL