HomeMy WebLinkAboutApplication for Place on the Ballot-11.05.2019-Fuller, Alexis2-22
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 OPTIONAL
APPLICATION FOR A PLACE ON THE e b e?ol SPECIAL ELECTION BALLOT
TO: City Secretary/Secretary of Board
I rerllrest 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.)
(�i- y (�ouncI' I , Itsty, icf I
FULL NAME (First, Middle, Last) _
/41ex1 5 Sose�G, E--J r.
PERMANENT RESIDENCE ADDRESS (Do not include a P.O. Box or Rural
Route. If you do not have a residence address, describe the address
at which you receive personal mall and location of residence.)
1 OtJ3 1 A1E lk Sf,
PRINT NAME AS YOU WANT IT TO APPEAR ON THE
t4lex Ft ((er
PUBLIC MAILING ADDRESS (Campaign mailing address, if available.)
r. o. box a 9 6,5
CITY YST7E ZIP CITY STATE ZIP
Geo,gefacur� 781oa� Geor ��c,�sn7VOTER REGISTRATION VUID
PUBLIC EMAIL ADDRESS (If available)CUPATION (Do not leave blank) DATE OF BIRTH NUMBER (Optional)2
alex� Qlex-��!(erla0/�fforneY 3 a �'1 1131oy9ylo5�l�d1 /
TELEPHONE CONTACT INFORMATION (Optional) LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN
IN STATE IN TERRITORY FROM WHICH THE
OFFICE SOUGHT IS ELECTED3
Home:
Work:
Cell
14 g year (s)
5I - b33 - ob17o _
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.
I S year (s)
/6 mo
Before me, the undersigned authority, on this day personally appeared (name)
I --X F—G- 1 e r who being by me
here and now duly sw+orn, upon oath says: I
"I, (name) [e,X 7 e r of f r OL W'& 0-r) County, Texas, being a
candidate for the office of i unc r+s re } 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 I i things tru nd co ect."
SIG ATURE OF CANDIDATE
Sworn to and subscribed before me at
-
rminO4
Cionmhkr % of fra
this the J+A- day of
Title of
TO BE COMPLETED BY CITY SECRETARY OR SECRETARY F BO RD:
(See Section 1.007) n� I l OI
Date Received
Si ature of ecretary
ROM LOUISE DEI
My Notary ID # 121
E)$w Apra 15,
Voter Registration Status Verified