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HomeMy WebLinkAboutApplication for Place on Ballot- 08.14.2013-Stump,BonnieAW2-18, 712011 Prescribed by Secretary of State Sections 141.031, 203.005, Chapter 204, Texas Election Code All information is required to be provided unless indicated as optional. APPLICATION FOR A PLACE ON THE BALLOT (Special Election to Fill a Vacancy) TO: Secretary of State I request that my name be placed on the above-named official ballot as a candidate for the office indicated below. OFFICE SOUGHT PARTY AFFILIATION (if any) Incc^lude any place number or other distinguishing number-,i�f`�any. ^ LnCt ✓i4r,c2, CJ2(a pWn �t� FULL NA (First,,, Middle, LasOJ PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT vrvt tt3b�tv��e�IneONNt eJ"C t1Nl}� � PERMANENT RESIDENCE ADDRESS (Street address and apartment MAILING ADDRESS (If different from residence address) number. If none, describe location of residence. Do not include P.O. Box or Rural Rt.) 5 A m e_ STATE ZIP CITY STATE ZIP CITY j f p EMAIL A DRESS (OPTIONAL) OC U `ATION (D9 not leave blytk) DATE OF BIRTH COUNTY OF RESIDENCE W����,Sor. ) � ` � �,jt5 � TELEPHONE NUMBER (Include area code) (Optional) U U Length of Continuous Residence as of Date Application Swom _ mos _ MOS _ MOS 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) 80AV1'*C, h �}+-yo who being by me here and now duly sworn, upon oath says: "I, (name) nw: Lott of W,l ia.m.Ta,. /+ County, Texas, being a candidate for the office of C4�4 C. ( ' Dki rzcA L swear that I will support and defend the Constitution and laws of the United States and -6f 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 are in all things true and correct." � A JESSICA ERIN BRMLE s ' " NOTARY PUBLIC '- State of Texas ONM. Exp. 06-09-2095 SIGNATURE OF CANDIDATE i (,`� this the_ day of �i worn t and subscribed re me at __,• SEAL 41 0�� �p i i `• VVI:.^"'"' \.+ 1! Sign re f Officer admi is ring oath' Title of 0 t er administering ath TO fZOMPLETED BY SECRETARY OF STATE: This document and $ filing fee or a nominating petition of pages received. (See Section 1.007) Date Received Signature of Receiving Officer INSTRUCTIONS AND FOOTNOTE ON BACK AW2-18 7/2011 INSTRUCTIONS The application must be fled with the Secretary of State not later than 5:00 p.m. of the filing deadline stated in the election order. The application must be accompanied by a filing fee or a petition in lieu of a fling fee. The filing fees are: U.S. Senator $5,000.00 U.S. Representative $3,125.00 State Senator $1,250.00 State Representative $ 750.00 In lieu of a fling fee, the application must be accompanied by a petition signed by registered voters of Texas, in the case of a statewide office, or registered voters of the district, in the case of a district office. The number required is: U.S. Senator All District Offices 5,000 500 The form for the petition in lieu of a filing fee is available from the Secretary of State's Office. The candidate must sign this statement indicating his awareness of the nepotism law. The nepotism prohibitions of chapter 573, Government Code, are summarized below: No officer may appoint, or vote for or confirm the appointment or employment of any person related within the second degree by affinity (marriage) or the third degree by consanguinity (blood) to himself, or to any other member of the governing body or court on which he serves when the compensation of that person is to be paid out of public funds or fees of office. However, nothing in the law prevents the appointment, voting for, or confirmation of anyone who has been continuously employed in the office or employment for the following period prior to the election or appointment of the officer or member related to the employee in the prohibited degree; six months, if the officer or member is elected at the general election for state and county officers. No candidate may take action to influence an employee of the office to which the candidate is seeking election or an employee or officer of the governmental body to which the candidate is seeking election regarding the appointment or employment of a person related to the candidate in a prohibited degree as noted above. This prohibition does not apply to a candidate's actions with respect to a bona fide class or category of employees or prospective employees. Examples of relatives within the third degree of consanguinity are as follows: (1) First degree: parent, child; (2) Second degree: brother, sister, grandparent, grandchild; (3) Third degree: great-grandparent, great-grandchild, uncle, aunt, nephew, niece. These include relatives by blood, half-blood, and legal adoption. Examples of relatives within the second degree of affinity are as follows: (1) First degree: spouse, spouse's parent, son-in-law, daughter-in-law; (2) Second degree: brother's spouse, sister's spouse, spouse's brother, spouse's sister, spouse's grandparent. Persons related by amity (marriage) include spouses of relatives by consanguinity, and, if married, the spouse and the spouse's relatives by consanguinity. These examples are not all inclusive. FOOTNOTE 'All oaths, affidavits, or affirmations made within this State may be administered and a certificate of the fact given by a judge, clerk, or commissioner of any court of record, a notary public, a justice of the peace, city secretary, and the Secretary of State of Texas.