HomeMy WebLinkAboutApplication for Place on the Ballot - Gipson - 01.28.2015AW2-15,7/2011
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-narned official ballot as a candidate for the office indicated below.
OFFICE SOUGHT Include any place number or other distinguishing number, if any.
INDICATE TERM
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�FULL UNEXPIRED
FULL NAME (First, Middle, Last)
PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT
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Gk P son
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
6wa
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EMAIL ADDRESS (Optional)
OCCUPATION (Do not leave blank)
DATE OF BIRTH
VOTER REGISTRATION VUID NUMBER
owne�r
(if applicable)
mi(lulk"11 Press
TELEPHONE NUM13ER (Include area code) (Optional)
Length of Continuous Residence as of Date Application Sworn
OFFICE:
2 MOS MOS G 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 apolitical, 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) T 14 C-CAWQ-V-a who being by me
here and now duly sworn, upon oath says: "I, (name) Cj 12 5_AIZA of L'st I I i Soy y
County, Texas, being a candidate for the office of _ Di S.r-,- !;� . 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."
S NA t3F IRATE
S7wand subscribed before meat 10'00AY-vA this the day of 3—ab-0�-
SEAL
Si ature of Officer administering oath2 Title of OffliUeadministering oath
..........
TO BE COMPLETED BY CITY SE JESSICA ERIN BRMLE
NOTARy PUBLIC
(See Section 1.007) state 0i TOMS 0
...... . *
Ex p-06-01-2015 Date Received Si attire of City Secretary
comm.
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