HomeMy WebLinkAboutApplication for Place on the Ballot 01.15.2026 Schroeder, Joshuia2-26
Prescribed by Secretary of State
Section 141.031, Chapters 143 and 144, Texas Election Code
09/2021
APPLICATION FOR A PLACE ON THE BALLOT 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 application.
APPLICATION FOR A PLACE ON THE ''� �, �� >C GENERAL ELECTION BALLOT
TO: City Secretary/Secretary of Board (nani of election)
I request that my name be placed on the above -named official ballot as a candidate for the office i dicated below. i
OFFICE SOUGHT (Include any place number or other distinguishing number, if any.) 1NDIC TERM
❑
cJf fog P w/\ FULL UNEXPIRED
FULL NAME (€' st, Middle, Last)
PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT*
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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 correspondent�
CITY
STATE
ZIP
CITY
STTATE
ZIP
7
PUBLIC EMAI ADDRESS (Optional) (Address for
OCCUPATION (Do not leave blank)
DATE OF BIRTH
VOTER REGISTRATION VUID
which you receive campaign related emails, if available.)
AL6,rnes
! ^ !
NUMBERZ (Optional)
/
ELEPHON N CT INFDR ATION (Optional)
Home: Office: Cell:
FEL05WONVICTION STATUS (You MUST check one) LENGTH OF CONTINUOUS RESIDENCE AS OF DATE THIS APPLICATION WAS SWORN
I 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 WHICH THE OFFICE SOUGHT IS ELECTED
� Year(s) year(s)
_L_!?L
pardoned or otherwise released from the resulting
disabilities of that felony conviction and I have provided t
month(s) month(s)
proof of this fact with the submission of this ap lication.3
*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. I 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 for how names may be listed on the official ballot.
(I--
Before me, the undersigned authority, on this day personally appeared (name ofcandildate) S►ay f�L#-pe_6L_,' who
being by me here and now duly sworn, upon oath says: , A
"I, (name of candidate) �.2 S h � _ �" e� , of W r' t 1 i G ¢ten County, Texas,
being a candidate for the office of V`A CG c4z d Av�ri , swear that I will support and defend the Constitution and
laws of the United States and of the State of Tex . I am a citizen of the th)itedligible 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 Code. 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 am aware that knowingly providing false information ❑ e pplication regarding my possible felony conviction
status constitutes a Class B misdemeanor. I further swear that the foregoing statements ' tlud in my application are in all things true and correct."
X
SIGNATURE !DATE
Sworn to and subscribed before me this the ) if - -day of :7PZ1 by . %__ _ _JA . C:�k_IMeC&.� _-
(day) (month) (year) (name of candidate)
Signature of fficer Authorized to Administer Oath4 Priiiied-ilarnebf In fildowkw Oath
lallotiry
ROBYN LOUISE DENSmORE
10 bt25557056
Title of Offic Authorized to Administ�ath LAY Commission Expires
TO BE COMPLETED BY FILING OFFICER: THIS APPLICATION IS ACCOMPANIED BY THE f QM11:EJ)%fILING PI?E"(IFA00 itable) NAID BY:
❑ CASH ❑ CHECK ❑ MONEY ORDER ❑ CASHIERS CHECK OR ❑ PETITION IN LIEU
This document and $ filing fee or a nominating petition of pages received. 1=1 Voter Registration Status Verified
5 (See Section 1.007)
Date Received Date Accepted Signature o 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 political subdivision, 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 141.035, 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. http:/Iwww.sos.state.tX.u5/elections/lawslhb484-fag.shtml
3Proof 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 48.05
'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 State of Texas. See Chapter 602 of the Texas Government Code for the complete list of persons authorized to
administer oaths.