HomeMy WebLinkAboutApplication for Place on Ballot 01.18.2023- Hood, Shawn2-26
Prescribed by Secretary of State
Section 141.031, Chapters 143 and 144, Texas Election Code
09/2021
APPLICATION FOR A PLACE ON THE BALLOT FOR A GENERAL ELECTION
FOR A CITY, SCHOOL DISTRICT OR OTHER POLITICAL SUBDIVISION
ALL INFORMATION IS REQUIRED TO BE PROVIDED UNLESS IN ICATED AS PT10 ALl Failure tQ provide requirp0jinf rmatlon may result in rejection of application.
APPLICATION FOR A PLACE ON THE QQ(Q �ENERAL ELECTION BALLOT
TO: City Secretary/Secretary of Board (name of election)
I request that my name be placed on the above -named official ballot as a candidate for the of ' e indicated below.
e y OFFICE SOUG T K cludplace number or o er distingui g number, if any.)
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IND ATE TERM
❑
FULL UNEXPIRED
FULL NAME (First, Middle, Last)
PRINT NAME AS YOU WANT IT TO APPEARON THE BALLOT*
Aug4kawi�-
. r��PERMAN
T RESIDENCE ADDRESS (Do not include a P.O. Box or Rural Route. If
PUBLIC MADDRESS (Optional) (Address for which you receive
you do not Wwe
related correspondence, if available.)
CITY
STATE ,
ZIP
CITY
STATE
ZIP
PUBLIC EMAIL ADD (Optional) (Address for OCCUPATION (Do not leave blank) DATE OF BIRTH VOTER REGISTRATION VUID
which you receive campaign related emails, if available.) L� I ,^I O� `! / (Optional)
TELEPHONE CONTACT INFORMATION (Optional)
Hom : Office: Cell:
FI NY CONVICTION STATUS (You MUST check one)
LENGTH OF CONTINUOUS RESIDENCE AS OF DATE THIS APPLICATION WAS SWORN
I have not been finally convicted of a felony.
IN THE STATE OF TEXAS
IN TERRITORY/DISTRICT/PRECINCT FROM
I have been finally convicted of a felony, but I have been
Year(s)
WHICH THE OFFICE SOUGHT IS ELECTED
year(s)
pardoned or otherwise released from the resulting
disabilities of that felony conviction and I have provided
month(s)
proof of this fact with the submission of this application.3
_
months)
*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 or contain a title, 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. Please review sections 52.031, 52.032 and 52.033 of the Texas
Election Code regarding the rules for how names may be listed on the official ballot.
r
Before me, the undersigned authority, on this day personally appeared (name of candidate)who
being by me here and now duly sworn, upon oath s ys:
J
"I, (name of candidate) of or,— County, Texas,
being a candidate for the office of _ C swear that I will support and defend the Constitution and
laws of the United States and of the State of Telas. 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 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 am aware that I must disclose
any prior felony conviction, and if so convicted, must provide proof that I have been pardoned or otherwise released from the resulting disabilities of
any such final felony conviction. I am aware that knowingly providing false information on the applicatio egar 'ng possible felony conviction
status constitutes a Class B misdemeanor. I further swear that the foregoing state nts eluded in my ap icatio are II things true and correct."
X
SIGNATURE OF CANDIDATE
Sworn to and subscribed before me this the A�Nay of ZQy.J by li F.
(day) (month) (year) (name of candidate)
19 ZbLk
Signature of offi r Authorized to Administer Oath4 Printed N ath
►�` '�a ROBYN LOUISE DENSMORE
Notary ID #125657056
Title of Offtc r Authorized to Administer ath s, my Commission Expires
TO BE COMPLETED BY FILING OFFICER- THIS APPLICATION IS ACCOMPANIED BY THE R U ING F le) P D BY:
❑ CASH ❑ CHECK ❑ MONEY ORDER ❑ CASHIERS CHECK OR ❑ PETITION IN LIEU O
This document and $ filing fee or a nominating petition of pages received. Voter Registration Status Verified
d \ / 1 f7 / ZOZ3 01 /�Z JOV3 (See Section 1.007)
Date Received Date Accepted Signature e Filing ❑ ficer or Designee