HomeMy WebLinkAboutApplication for Place on the Ballot 05.04.2019-Fought, SteveZ -Z1
Prescribed by Secretary of State
Section 141.031, Chapters 143 and 144, Texas Election Code
1/2017
ALL INFORMATION 1S RG UIRED TO BE PROVIDED UNLESS INDICATED OPTIONAL
APPLICATION FOR A PLACE ON THE t" AA_19 GENERAL FLFC_TION RAI I OT
TO: City Secretary/Secretary of Board
I request that my name be placed on the above-named official ballot as a candidate for the office indicated below.
E OFFICE SOUGHT (Include any, number or other distinguishing number, if any.)
INDICATE TERM
place
KFULL
E
E]UNEXPIRED
FULL NAME (First, Middle, Last)
PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT'
1 PERMANENT RESIDENCE ADDRESS (Do not include a P.O. Box or Rural PUBLIC MAILING ADDRESS (Campaign mailing address, if available.)
Route. If you do not have a residence address, describe the address ,�
at which you receive personal mail and location of residence.) �
T,r 7e4-7-2
00
I CITY STATE ZIP CITY STATE ZIP
77,f �& ,f 7 1
PUBLIC EMIL ADDRESS (If available) OCCUPATION (Do not leave blank) I DATE OFBIRTH VOTER REGISTRATION VUID
NUMBER (Optional) Z
I've,/1b 1/4
- /
TELEPHONE CONTACT INFORMATION (Optional) LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN
Home 00 �
6 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)���►V who being by me
here and now duly sworn, upon oath says:
"l, (name)i of AA&4reA*syN County, Texas, being a
candidate for the office of _, swear that I will support and defend the Constitution and laws
of the United States and of the State of Texas. I m 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 a d correct"
X 7 r 7
SIGNATURE OF CANDIDATE
I Sworn to and subscribed before me at % !1 this the A5PLday of
SEAL
12,
�AA -5fLf&WM_A
CS`ignatur of O icer Administering Oath' Title of icer Administering Oa h
TO BE COMPLETED BY CITY SECRETARY OR SECRETARY OF BP.ARD:�
(5ee Section i.uur) U t 111 D L&19L__\
Date Received
1 Voter Registration Status Verified