HomeMy WebLinkAboutWalton, Michael_Application for Place on Ballot2-21
Prescribed by Secretary of State
Section 141.031, Chapters 143 and 144, Texas Election Code
1/2017
ALL INFORMATION IS REQUIRER TO BE PROVIDED UNLESS INDICATED OPTIONAL
APPLICATION FOR A PLACE ON THE Z Z 0 GENERAL ELECTION BALLOT
TO: City Secretary/Secretary of Board
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
`J FULL
LJUNEXPIRED
FULL NAME (First, Middle, Last) I PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT`
PERMANENT RESIDENCE ADDR SS. (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 mail and location of residence.)
J%k 0 6 V-, \ s-''0 ~ S-� rce_-t
h ; cLe-0
PUBLIC MAILING ADDRESS (Campaign mailing address, if available.)
1406 E
CITY STATE ZIP CITY STATE ZIP
� —7 z6 o . - _ _ `Ili 8 6'z
PUBLIC EMAIL ADDRESS (If available) OCCUPATION (Do not leave blank) DATE OF BIRTH VOTER REGISTRATION VUID
NUMBER (Optional)'
i l✓GC\�OY.'�c9r �`)��iC��, C �� ! tOc�+ClC?r / -2 6 Iq 1 % 3 06 `i 7 /
TELEPHONE CONTACT INFORMATION (Optional) �{ LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN
Home: IN STATE IN TERRITORY FROM WHICH THE
OFFICE SOUGHT IS ELECTED
Work: p year (s) % year (s)
Cell: `� `Z - 5 -7 3 '- -70 2 month[sj i 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 (name) tA i C-L, 1�1 '6-1 1�1/CAA-0 who being by me
here and now duly sworn, upon oath says:
(name) Lu a-L1 wkNIt. ^ of �4i ; �� i t� S County, Texas, being a
candidate for the office of L swear that I will support and defend the Constitution and laws
of the United States and of the State of Yexas. 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 tr and orrect."
X
Sworn to and subscribed before meat / % , this the ay of
of Officer Administering Oath
Title of
TO BE COMPLETED BY CITY SECRETARY OR SECR RY OF)BOARD:
(See Section 1.007) o 2-0
..� Date Received
Voter Registration Status Verified h
QATURE OF CANDIDATE
Oath
re of Secretary