HomeMy WebLinkAbout190722 - Candidate Application - Jerome RektorikRECEIVED
ALL INFORMATION IS REQUIRED TO BE PROVID
2-21
Prescribed by Secretary of State
Section 141.031, Chapte rs 143 and 144, Tex as Election Code
1/2017
APPLICATION FOR A PLACE ON THE ---~~'---'~"'1'-4.+..a.=-.1""-+..:a...c:a..o.-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
sf~ h'Pn t/ ~ fp 1111 ,;J _ ? At-e z. ~FULL
.J D UNEXPIRED
PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT1 ~tfDRJ J<. <feR. D
FULL NAME (First, Middle, Last)
II 01{11 e. ~ ..Ji I!-t> ,,,~
PERMANENT RESIDENCE ADDRESS (Do not include a P.O. Box or Rural
Route . If you do not have a residence address, describe the address
"7;,;o;""wt ~J::~;rat~~~t•11o /(,
CITY
PUBLIC MAILING ADDRESS (Campaign mailing address, if available.)
CITY
STATE
VOTER REGISTRATION VUID
NUMBER (Optional) 2
I OAl-11/Z. f If
TELEPHONE CONTACT INFORMA ptional) LENGTH OF CONTINUO S RESIDENCE AS OF DATE APPLICATION SWORN
Home: 91f · Slf-~, 2. 1 z r
Work:
Cell:
IN STATE
flyear(s)
_l_month(s)
IN TERRITORY FROM WHICH THE
OFFICE SOUGHT IS ELECTED'
L.j_ year (s)
_j_ 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) j:f t>fl.AC e. .:Jf aotrt ·l J(eKf17.Jk,;b 1~ by me
here and now duly sworn, upon oath says:
"I, (name) J 8 R 4 Z () S County, Texas, being a
candidate for the office of swear that I will support and defend the Constitution and laws
of the United States and of the Sta of exas. I am a citizen o 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 pr ate jurisdlctio o e totally mentally incapacitated or
partially mentally incapacitated without the right to vote. I am aware of the nepo · la , Chapter 57 , Go ernment Co
I further swear that the foregoing statements included in my application are i
x
Sworn to and subscribed before me at 1240827
S~ry Public, State f Te>eaa
My ComminiOn 1)4191
February 15, 22
TO BE COMPLETED BY CITY SECRETARY OR SECRETARY OF BOARD:
(See Section 1.007) 7~ 22.. -1'1
Voter Registration Status Verified rd' Date Received