HomeMy WebLinkAboutApplication for a Place on the Ballot-01.15.2021-Calixtro,Mary2-21
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 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
1 FULL
COUNCIL Dlsr_ t ■ UNEXPIRED
FULL NAME (First, Middle, Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT'
MART MAODALCS&A C'ALIjc-P-d MAky %-41 �
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.)
Q D `0 04ST '2 Z-, C( S -r.
CITY
STATE
ZIP
CITY
STATE ZIP
C%E012C-76TOWn1
/�
y9(e2(o
PUBLIC EMAIL ADDRESS (If available) OCCUPATION (Do not leave blank) DATE OF BIRTH VOTER REGISTRATION VUID
2
NUMBER (Optional)
jI
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: �
J?0 year (s) year (s)
cell:
months) 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)_ who being by me
here and now duly sworn, upon oath says:
,
y�y"�r "I, xb w being
(name) Y� �of _ _ _ _ County, Texas, a
candidate for the office of I Q. , 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 all things true and correct."
X
GNATUREOF
Sworn to and subscribed before me at , this the day of KAREN FROST
— Notary ID 53608-4
My Commission Expires
May 24, 2024
Signature of Officer Administering Oath Title of Qf �cer Ad inisterin Oa
TO BE COMPLETED BY CITY SECRETARY OR SECRET rRY 0 BOARD -
(See Section 1.007) 1 as 20
Rate Received Signature of Secretary
Voter Registration Status Verified