HomeMy WebLinkAbout170725 - Candidate Application - Bob Brick • Jul, 25, 2017 8: 49AM No. 1433 P. 2
2.21
Prescribed by Secretary of Star.
• Ssctlon 141.031,chapters 1.48 and 144,Tex-as Herbal-1 Cade
1/2017
All INFORMATION IS REOUIRf,D TO BE PROVIDED UNLESS INDICATED OPTIONAL
APPLICATION FOR A PLACE ON THE (';f+ 1) S-Imo'--fi r (y 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
e�l.4 l �0� )ti( ; I r.e(C � 1 ,r"+FULL
I---1 UNEXPIRED •
FULL NAME(First,F1iddle,Last) PRINT NAME AS YOU1 WANT iT TO APPEAR ON THE BALLOT1
Z b b{J� ti 0-"yh Y r 1 C j 0 J r 1 C- }
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.)
)
CITY - STATE ZIP CITY STATE ZIP
C I10- 3t 1 • 1 X 7if-S-- -
PUBLIC EMAIL ADDRESS(If available) OCCUPATION(Do not leave blank) DATE OF BIRTH VOTER REGISTRATION VUID
. NUMBER(Optional)z
TELEPHONE CONTACT INFORMATION(Optional) LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN
Home:
7
� month(s) 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.V `
Before me,the undersigned authority,on this day personally appeared(name) \ L who being by me
here and now duly sworn,,, upon oath says:
"I, (name) cm6b�Tlt vA)' * .r i GIC . of S( 2-o County, Texas, being a
candidate forthe office of c _11 5-1i i /-r\ f,}y dt-r c.J —j,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. f 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 d correct!'
X ( k.) 1
c . SIGN TURE OF CANDIDATE
Swo to and subseri ed before ride at �T-i��' this th day of - � ?��,_,���__•x
(%f�S f' YF-- Ate. o N,R P u Li 4
r6,yt✓� 1.76. / sir Tfi „„,,' P} f.i�ND n'
Aithwy �t l��ye �s,l 3 4
i ,��/ i-yg,i:e;:ir' ,FIATe'r v;YOMING
a .ieW,i:! couf;ry c�:aarROW
... ;.,y rr�mh�'en:1i;•.•eS .I.,. is
n
itigna re of Of r Administering Oath4 Title of Officei1Administering Oaths���'
TO BE COMPLETED BY CITY SECRETARY 0R SECRETARY,!�IOF BOARD.
r
(See Section 1.007) ' -a 5 a h G?�i L-G , - -
Date Received Signature of Secretby
Voter Registration Status Verified lil n Al' ift .