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HomeMy WebLinkAboutHesser_Place on the Ballot_05.04.2019ALL INFORMATION IS HCCQUIRED TO BE PROVIDED UNLESS INDICATED OPTIONAL APPLICATION FOR A PLACE ON THE TO: City Secretary/Secretary of Board z -z1 Prescribed by Secretary of State Section 141.031, Chapters 143 and 144, Texas Election Code 1/2017 GENERAL ELECTION BALLOT uest 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 distinIulshing number, if any.) e-�p60l AJ / LJ UNEXPIRED PRINT NAM AS YOU WANT IT APPEAR ON THE BALLOT' TE TERM LL FULL NAME (First, Middle, Last) ,1,#,k1M k j�-F1 �) 14c-_sE&R PERMANENT RESIDENCE 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.) zoo tZci) "?aP�y7'"IL, PUBLIC MAILING ADDRESS (Campaign mailing address, if available.) TOA I L CI TY��©� � STATE ZIP CITY STATE ZIP leTyr 7� 3l6ve� �-yA x /,p PUBLIC EMAIL ADDRESS (If available) OCCUPATION (Do not leave blank) DATE OF BIRTH VOTER REGISTRATION VUID NUMBER (Optional) 2 TELEPHONE CONTACT INFORMATION (Optional) Home: 51-2-o,6�7 2-0 al) Work: p Cell: LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN IN STATE IN TERRITORY FROM WHICH THE OFFICE SOUGHT IS ELECTED Ll year (s) AL year (s) _J_ 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)___)0V\ n dcye4 who being by me here and now duly sworn, upon oath says: (name) - )()h.iq of�UL)Il1_ l ��j>'� County, Texas, being a candidate for the office of :, + A' ' 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 ar in a thin s true and X . c N Sworn to and subscribed before me at of 00r6er Administering Oath 51GNATLAE OF CANDIDATE this the day of� Title of TO BE COMPLETED BY CITY SECRETARY OR SECRETARY OF` BOARD: (See Section 1.007) 0\ 12,51 %0 11A Date Received Voter Registration Status Verified u ature ofSe�retary SEAL