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Home My WebLink AboutApplication for Place on the Ballot- Butler, Benjamin 01.15.20252-26 Prescribed by Secretary of State Section 141.031, Chapters 143 and 144, Texas Election Code 09/2021 APPLICATION FOR A PLACE ON THEE ALLOT FOR A GENERAL ELECTION FOR A CiTY, SCHOOL DISTRICT OR OTHER POLITICAL SUBDIVISION ALL INFORMATION iS REQUIRED TO BE PROVIDED UNLESS INDICATED AS OPTIONAL' Failure to provide required information may result in rejection of applicatian- APPLICATION FOR A PLACE ON THE +Co�,ear G) r r4 GENERAL ELECTION BALLOT TO: City Secretary/Secretary of Board (name of election) 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 6:r (�j d'rL L/ - T 1r FULL 1 1 UNEXPIRED FULL NAME (First, Middle, Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT* 1� Q PERMANENT RESIDENCE ADDRESS (Do not include a P.O. Box or Rural Route. if PUBLIC MAILING ADDRESS (Optional) (Address for which you receive you do not have a residence address, describe location of residence.) campaign related correspondence, if available.) CITY STATE ZIP CITY STATE ZIP 'e► ,s 7"C , 79� 3 3 PUBLIC EMAIL ADDRESS (Optional) (Address for OCCUPATION (Do not leave blank) DATE OF BIRTH VOTER REGISTRATION VUiD which you receive campaign related emalls, if available.) / j + NUMBER2 (Optional) TELEPHONE CONTACT INFORMATION (Optional)' Home: Office: Cell:' FELONY CONVICTION STATUS (You MUST check one) LENGTH OF CONTINUOUS RESIDENCE AS OF DATE THIS APPLICATION WAS SWORN - 1 have not been finally convicted of a felony: IN THE STATE OF TEXAS IN—TERRITORY/DISTRICT/PRECINCT FROM I have been finally convicted of a felony, but I have been � c years) WHICH THE OFFICE SOUGHT IS ELECTED pardoned or otherwise released from the resulting year(s) disabilities of that felony conviction and I have provided 2 month(s) proof of this fact with the submission of this application.3 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 or contain a title, nor does it indicate a political, economic, social, or religious view or affiliation. 1 have been commonly known by this nickname for at least three years prior to this election, Please review sections 52.031, 52.032 and 52.033 of the Texas Election Code regarding the rules how names may be listed on the official' ballot. Before me, the undersigned authority,; on this day personally appeared (name of candidate) a!7', GSA' who being by me here and now duly sworn, upon oath says: �} "i, (name of candidate) �.�'' 11{o4L-zs t,�ta.7 _ of ,x County, Texas, being a candidate for the office of ,t C/f C" s d r' 3 , 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 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 Cade. I am aware that I must disclose any prior felony conviction, and if so convicted, must provide proof that I have been pardoned or otherwise released from the resulting disabilities of any such final felony conviction. I em aware that knowingly providing false information on the application regarding my possible felony conviction status constitutes a Class B misdemeanor. I further swear that the foregoing statements included in my application are in all things true and correct." SIGNATURE OF CANDIDATE Sworn to and subscribed before me this the •'`clay of t '*�,t •,t by,e (day) (month) (year) (name of candidate) Signature o fficer Authorized o Administer Oaths Printed Na f Officer Authorized to Administer Oath Title of OTF a Authorized to Administer Oa 1 -, 1 DENSMORE TO BE COWETED BY FILING OFFICER: T iS APPLICATION iS ACCOMPANIED BY THE RE 1 t f VAI Y's CASH ❑ CHECK D MONEY ORDER CASHIERS CHECK OR ❑ PETITION IN LIEU Commission Expires OF F s cK April 15, 2026 This document and $ filing fee or a nominating petition of pages receive�� erified 'Z° 5 (See Section 1.007) 716k,�� LldA-4!c�� Date Received Date Accepted Signature of Filing Officer or Designee 2-26 Prescribed by Secretary of State Section 141.031 Chapters 143 and 144, Texas Election Code 09/2021 INSTRUCTIONS An application for a`place on the general election for a city, school district or other politicalsubdivision, may not be filed earlier than 30 days before the deadline prescribed by this code for filing the application. An application filed before that day is void. All fields of the application must be completed unless specifically marked optional. For an election to be held on a uniform election date, the day of the filing deadline is the 78th day before Election Day. If you have questions about the application, please contact the Secretary of State's Elections Division at 800-252-8683. NEPOTISM LAW The candidate must sign this statement indicating his awareness of the nepotism law. When a candidate signs the application, it is an acknowledgment that the candidate is aware of the nepotism law. The nepotism prohibitions of chapter 573, Government Code, are summarized below: No officer may appoint, or vote for or confirm the appointment or employment of any person related within the second' degree by affinity (marriage) or the third degree by consanguinity (blood) to the officer, or to any other member of the governing body or court on which the officer serves when the compensation of that person is to be paid out of public funds or fees of office. However, nothing in the law prevents the appointment, voting for, or confirmation of anyone who has been continuously employed in the office or employment for the following period prior to the election or appointment of the officer or member related to the employee in the prohibited degree: six months, if the officer or member is elected at an election other than the general election for state and county officers. No candidate may take action to influence an employee of the office to which the candidate is seeking election or an employee or officer of the governmental body to which the candidate is seeking election regarding the appointment or employment of a person related to the candidate in a'prohibited degree as noted ;above. This prohibition does not apply to a candidate's actions with respect to a'bona fide class or category of employees or prospective employees. FOOTNOTES 'An application for a place on the ballot, including any accompanying petition, is public information immediately on its filing. (Section 141.03S, Texas Election Code) 'inclusion of a candidate's VUID is optional. However, many candidates are required to be registered voters in the territory from which the office is elected at the time of the filing deadline. Please visit the Elections Division of the Secretary of State's website for additional information. htto://www.sos.state.tx.us/electionsflaws/hb484-fag.shtml 'Proof of release from the resulting disabilities of a felony conviction would include proof of judicial clemency under Texas Code of Criminal Procedure 42A 701, proof of executive pardon under Texas Code of Criminal Procedure 48.01, or proof of a restoration of rights under Texas Code of Criminal Procedure 48.05. (Texas Attorney General Opinion KP-0251) One of the following documents must be submitted with this application. Judicial Clemency under Texas Code of Criminal Procedure 42A.701 Executive Pardon under Texas Code of Criminal Procedure 48.01 Restoration of Rights under Texas Code of Criminal Procedure 48.03 "All oaths, affidavits, or affirmations made within this State may be administered and a certificate of the fact given by a judge, clerk, or commissioner of any court of record, a notary public, a justice of the peace, city secretary (for a city office), and the Secretary of Staieof'Te to . See` Chapter 602 of the Texas Government Code for the complete list of persons authorized to administer=oaths.