HomeMy WebLinkAboutPlace on the Ballot - Jonrowe - 05.2020ALL INFORMATION IS
TO BE PROVIDED UNLESS INDICATED OPTIONAL
APPLICATION FOR A PLACE ON THE
TO: City Secretary/Secretary of Board
2-21
Prescribed by Secretary of State
Section 141.031, Chapters 143 and 144, Texas Election Code
1/2017
GENERAL ELECTION BALLOT
I request that my name be placed on the above -named official ballot as a candidate forth e office indicated below.
OFFICE SOUGHT ((include any place number or other distinguishing number, if any.) INDICATE TERM
C�eorc�e%tVUI)Ifl Cf l fit.( YICI I �� (5"FI" 1 C� FULL
C UNEXPIRED
FULL NAME (First, Middle, Last)
PRINT NAME AS YOU WANT IT TO APPEAR ON THE
` (Achad �edvj i° G rei✓t h,C h '-Rachtel -3-on rot e-
PERMANENT RESIDENCE ADDRE (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 ,, ll
at which you receive personal mail and location of residence.) -12-l/t W�rs ` � Ave,
S. Clh "rC h 5+. 5+e 11 O -111 J
G eoroser wyl , T X �? ° G cor c' -town � 1 X
CITY
G eor e�o WY1
PUBLIC EMAIL ADDRESS (If available)
r'achaC 1 f-crJeC -foua
wy1d, . e o
STATE ZIP CITY
TX I-Cieca
OCCUPATION (Do not leave blank)
bitsiress owner
TELEPHONE CONTACT INFORMATION (Optional)
Home:
Work:
DATE OF BIRTH
(l / 10 ri to
STATE I ZIP
-Tx , �lo2io
VOTER REGISTRATION VUID
NUMBER (Optional) 2
LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN
IN STATE IN TERRITORY FROM WHICH THE
j OFFICE SOUGHT IS ELECTED
'i3
3 year (s) 1 year (s)
Cell: J Z month(s) 16) 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. _
Rafnra ma tha iinrlarcianarl aiithnrity nn thk rInv nprCnnally annparpd inamP] kctC. Y ��1i 1 C����-{ I C V ,who being by me
here and now duly sworn, upon oath says: `A `
"I, (name) a ci `ae 1 GIlLi l(^C of W 1 11'0 rn so I-) County, Texas, being a
candidate for the office of i' - L*'el swear that I will support and defend the Constitution and laws
of the United States and of the State of Texas. I anija 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
X <4
Sworn to and subscribed before me at W.
this the
Signature of ricer Administering Oath4 Title
TO BE COMPLETED BY CITY SECRETARY OR SECRETARY OF BOARD:
(See Section 1.007)�i 7Dw
Date Received
Voter Relzistration Status Verified
true and correct."
SIGNATURE OF CAN&DATE
day o-----
Oath
Sig nature o Se—c— ary
ROB'1' N40tJME DENSAtOjI
My Notary ID 0 1251
Expires Apd 15, 2=