HomeMy WebLinkAboutMcMichael_Place on the Ballot_05.2014AW2-l5,7t20lI
Prescribed by Secretary of State
Sections 141.031, 143.004, 143.006, Texas Election Code
All information is required to be provided unless indicated as optional.
APPLICATION FOR A PLACE ON THE CITY OF GENERAL ELECTION BALLOT
TO.- City Secretary
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.
INDICATE TERM
i-'
'EEl FULL 0 UNEXPIRED
0
FULL NAME (First, Middte,'Last)
PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT
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.)
CITY
STATE
ZIP
1
CITY
STATE
ZIP
7�7xzs
/
EMAIL ADDRESS (Optional)
OCCUPATION (Do not leave blank)
DATE OF BIRTH
VOTER REGISTRATION VUID NUMBER
Aso -.
applicable)
W S2L7�,
TELEPHONE NUMBER (Include area code) (Optional)
`;'l—ength of Continuous Residence as of Date Application Sworn
OFFICE:
IN STATE IN CITY IN DISTRICT OR PRECINCT'
3 Y Yr(S) yr(S) Yr(s)
HOME:
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 not 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 cl=tion,
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Before me, the undersigned authority, on this day persona 1) QAeV N\1-)N\"a,,k who being by me
here and now duly sworn, upon oath says: "I, (name) J -1 of W10t0-'V►r'
County, Texas, being a candidate for the office of M qua,. 'I swear that I will support and
defend the Constitution and laws of the United States and nfq&- State of Texas. I ant 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."
X
SIGNATURE OF CANDIDATE
Swom to and subscribed before me at this the t' day or �j
SEAL
Signature of Officer administering oath' Title of Officer&3steri-nQth
TO BE COMPLETED BY CITY SECRETARY:
(See Section 1.007)
reta
Date Received S' nature of City Secretary
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4
7777