HomeMy WebLinkAboutApplication for a Place on the Ballot - Reedholm - 05.04.2019ALL INFORMATION IS 8LQUIRED TO BE PROVIDED UNLESS
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 an the above-named official ballot as a candidate for the office indicated below -
OFFICE SOUGHT (Include anyplace number or other distinguishing number, if any.) IND LATE TERM
GeoRG l is Q�C� FULL
N �I1 � �IACIl_ � 4- ❑UNEXPIRED
FULL NAME (First, Middle, Last) PRINT NAME AS=OUWANT ITTO APPEAR ON THE BALLOT'
Jos�P� I ����LVA J o I�V"o L-"
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.)
ITY
Cvc-v� STATE
TT CITY j STATE 21P
f' ;J
PUBLIC EMAIL ADDRESS (If available) OCCUPATION (Do not leave blank) DATE OF BIRTH VOTER REGISTRATION VUID
NUMBER (Optional) Z
� it 3616713
TELEPHONE CONTACT INFORMATION (Optional) LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN
Home: S' Z_ Q� s� IN STATE IN TERRITORY FROM WHICH THE
O
work: OFFICE SOUGHT IS ELECTED3
(�l�'� 2�
year (s) year (s)
Cell: SIZ—_�-�p� G�..
month(s) 1 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
here and now duly sworn, upon oath says:
U L_
who being by me
"I, (name) —J 0.5 ff VPhO LlC) L of 1 t<UP+R'5 0--4 County, Texas, being a
candidate for the office of Sagom� ,M c �l C LNC Aut % t 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 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 in true an c r ect.
ake
SIGNATURE OF CANDIDATE
Sworn to and subscribed before me at Tf;y: ii i�'l_ this the Ab
` SEAL
tILA 5F V
Signature of fficer Administering Oath Title of OfWer Administering Oath
TO BE COMPLETED BY CITY SECRETARY OR SECRETARY OF OARD:
(See Section 1.007) (� +C 1 /-.a .�'
Date Received Signature of Secretary
Voter Registration Status Verified