HomeMy WebLinkAboutApplication for Place on Ballot-01.16.2020-Hood, ShawnALL INFORMATION IS F
UIRED TO BE PROVIDED UNLE
APPLICATION FOR A PLACE ON THE
TO: City Secretary/Secretary of Board
2-22
Prescribed by Secretary of State
Section 141.031, Chapters 143 and 144, Texas Election Code
1/2017
TED OPTIONAL
C:) % 6 0 SPECIAL 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 distinguishing umber if any.)
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FULL NA E First, Middle, Last)
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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.)
nTYGtovay� o[un STI!TjC ZIP
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PUBLIC EMAIL ADDRESS (If available)
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CONTACT INFORMATION (Optional)
Home:
CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN
IN STATE
IN TERRITORY FROM WHICH THE
OFFICE SOUGHT IS ELECTED
Work: year (s)
year (s)
Cell: ijl months) �� 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.
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Before me, the undersigned authority, on this day personally appeared (name) _�' A --In '' `'{ who being by me
here and now duly sworn, upon oath says:
(name) hA'wV1 r-- of Gi.{ iG�4ri�So'�1 County, Texas, being a
candidate for the office of oreoUlkej 4 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 5vernrent Code.
I further swear that the foregoing statements included in
my application ar
all th ngs true an corfect "
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VA
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IGNATURE 0 C
,:TE KAREN E FROST
Sworn to and subscribed before me at
this the of r' -
_. r day
NOTARY PUBL"TATE OF TD
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COMM. OMp5.24-2020
NOTARY ID 1053608-4
Signature of Officer Administering Oath"
Title of O
icerAainisteringg2t
TO BE COMPLETED BY CITY SECRETARY OR SECRETA Y Oq
BOARD:
-
(See Section 1.007) 115 1,00
Z
Date Received
Signature of Secretary
Voter Registration Status Verified I