HomeMy WebLinkAbout200720 - Candidate Application - Bob BrickRECEIVED
JUL 2 0 2020
Bi: ..... J§: .... J~.~.~
ALL INFOR VIDEO UNLESS INDICATED OPTIONAL
2-21
Prescribed by Secretary of State
Section 141.031, Chapters 143 and 144, Texas Election Code
1/2017
APPLICATION FOR A PLACE ON THE N" v (/,yw\ :.R c
TO: City Secretary/Secretary of Board
_, 2: 0 :Z..,D GENERAL ELECTION BALLOT ;
I request that my name be placed on the above-named official ballot as a candidate for the office indicated below .
FULL NAME (First, Middle, Last)
Ke>ha-r4-·Wa.yne
PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT 1
Tb Clb B r i <-k
PERMANENT RESIDENCE ADDRESS (Do not includ e a P.O. Box or Rural PUBLIC MAILING ADDRESS (Campaign mailing address, if availab le .)
Route. If you do not have a residence address, describe the address
at which you receive personal mail and location of residence.)
CITY
VOTER REGISTRATION VUID
NUMBER (Optional) 2
TELEPHONE CONTACT INFORMATION (Optional) LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN
Home:
Work :
IN STATE
':l.D year (s)
0 month(s)
IN TERRITORY FROM WHICH THE
OFFICE SOUGHT IS ELECTED 3
..2:.2_ year (s)
_!!!_ month(s)
If using a nickname as part of your name to appear on the ballot, you are also sign ing 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
common ly known by thi s nickname for at le ast three years prior to this election .
Before me, the undersigned authority, on this day personally appeared (name) \2.o b.e-\ "}j r ;c.. "-
here and now duly sworn, upon oath sa ys:
, who being by me
County, Texas, being a
_ _,,_!........!,~-=...._.."-= ....... ~F-'-'~"-('~--+------' swear that I will support and defend the Constitution and laws
of the United States and of the Stat of Texas. I am a citizen of the United States eligible to hold such office under the constitution and laws of
this st;ite.. I have not been finally convicted of a felony for which I have not been pardoned or had my full rights of citizenship r es tored by other
official action . I have not b ee n determined by a final judgment of a court exerc ising probate jurisdiction to b e 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 appl ication are in all th'
Sworn to and subscribed before me at C!·, o"2..,.,..._,, , this the ~ay of :S" '?
TO BE COMPLETED BY CITY SECRETARY OR SECRETARY OF BOARD:
(S ee Section 1.007) ? -,2 0 -.2.. O
Voter Registration Status Verified cef Date Received
Notary Puo1 1c . State of Texas
My c::i611riiss1on Expires
June 20 2021