HomeMy WebLinkAboutApplication for Place on the Ballot-07.28.2021-French, Joseph2-22
Prescribed by Secretary of State
Section 141.031, Chapters 143 and 144, Texas Election Code
1/2017
ALL INFORMATION IS REQUIRED TO BE PROVIDED UNLESS INDICATED OPTIONAI
APPLICATION FOR A PLACE ON THE N�oycmb ZV"3 ZOZI. SPECIAL ELECTION BALLOT
TO: City Secretary/Secretary of Board 6�I-7 cowtc,l 0;5N:1a (n
I request 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 number, if any.)
(JiS+y,cl-
FULL NAME (First, Middle, Last)
PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT'
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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.)
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CITY
STATE
ZIP
CITY
STATE
ZIP
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TX
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PUBLIC EMAIL ADDRESS (If available)
OCCUPATION (Do not lea=11anI,ATE
OF BIRTH
VOTER REGISTRATION VUID
NUMBER (Optional)z
pro cc.l •5cy
CONTACT INFORMATION (Optional)
LENGTH OF CONTINUOUS RESIDENCE
AS OF DATE APPLICATION SWORN
Home:
IN STATE
IN TERRITORY FROM WHICH THE
OFFICE SOUGHT IS ELECTED3
Work:
year (s)
$ year (s)
Cell: (73%) !
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) �o5c���. �o�dr..-N rPe>1cL, who being by me
here and now duly sworn, upon oath says:
1, (name) �o�cr� �o�d�>n �irrcL• �Z of Willi-,Vy150✓t
County, Texas, being a
candidate for the office of C i+3 Cavyi6l 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 1 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."
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SIGNATURE 0 C N I A E
Sworn to and subscribed before me at g4,4�ithis the day of PL REN FROST
_ Notary ID #6084
N� My Commission Expires
eoF`�+P
May 24, 2024
Signature of Of icer Administering Oath° Title okfft4r AdRaidsterjng Oath
TO BE COMPLETED BY CITY SECRETARY OR SECRETA _- B ARD:
(See Section 1.007) 3
D to Received Signature of Secretary
Voter Registration Status Verified