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HomeMy WebLinkAbout200720 - Candidate Application - John Nichols RECEIVED .�$ 2-21 ,�y► Prescribed by Secretary of State Section 141.031,Chapters 143 and 144,Texas Election Code 1/2017 j;E9UIRED TO BE PR VIl3ED UNLESS INDICATED OPTIONAL APPLICA�I�............,................ . 4 L ALL INFORMAT I liulu ll-Un w rl.r�CE'6NI THE �` �� S1'l Yl�lll , 4l 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 Ln FULL ❑UNEXPIRED FULL NAME(First, Middle, Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT1 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 college O'Pti. 'T/< 77$"10 PUBLIC EMAIL /ADDRESS �(If available) OCCUPATION(Do not leave blank) DATE OF BIRTH VOTER REGISTRATION VUID NUMBER(Optional) 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:/ ,,/6 year(s) `? year(s) Cell: ® month(s) C 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. / r Before me,the undersigned authority,on this day personally appeared(name) ©�bt �{ L�G! ©(S who being by me here and now duly sworn,upon oath stays: I "I, (name) 117Vld'� �� I C_ ho I J of �//1 ��G ,vim . y2� � County, Texas, being a candidate for the office of C)`f 4 'Cor 1. x,;/ P/1i _1- 5� swear that I will suAort and defend the Constitution and laws of the United States and of the Stge 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 nol.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. 1 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 i s�t'rue'and and 11 G i/ ( _ _ SIGNATURE F t TE IAIi 0 9Q46S52.2 I Sworn to and subscribed before me at ob �•� this the�_day of �a.l.. * Notary Public. State of Texas f U 4 My Corringe Expires 1 June 2 .$0 021 I Signature of Officer Administering Oath4 Title of OffiLr Administering Oath I, TO BE COMPLETED BY CITY SECRETARY OR SECRETARY OF BOARD: (See Section 1.007) 9' 7-0 — ZO Date Received Sig ature Secretary Voter Registration Status Verified