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HomeMy WebLinkAbout210719 - Candidate Application - Dennis MaloneyALL INFORMATION IS REQUIRED TO BE PROVIDED UNLESS IN RECEIVED JUL l .-' l\J I 2-2 1 Prescr ibed by Secretary of State Sectio n 141.03 1, Chapters 143 and 144, Te xas Elec ti o n Code 1/2017 APPLICATION FOR A PLACE ON THE __ __."""--!-......._+-__,.,"""-"'-=<--=-~_,__--GENERAL ELECTION BALLOT TO: City Secretary/Secretary of Board I request that my name be placed on the above-nam ed official ballot as a ca ndid ate for the office indi cated below. OFFICE SOUGHT (Inclu de any place number or other distinguishing number, if any.) INDIC,ATE TERM O/q / gULL v I, e (/ Du NE XP IRED FULL NAME (Fir st, Middle, Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT 1 J>e~ µ,·./ ve;v,.u1.:r PERMANENT RESIDENCE ADDRESS (Do not in clud e a P.O. Box or Rural PUBLIC MAILING ADDRESS (C ampaig n mailing aadress, if ava il ab le .) Route. If you do not have a residence address, describe the ad at qcJoJ ~cee;;;;il i;~:es id e n ce .) / ~ (}~_(: CITY STATE ZIP C.1- PUBLIC EMAIL ADDRESS (If ava il ab le) TELEPHONE CONTACT INFORMATION (Opti ona l) Hom ff W ork : Ce ll: CITY DATE OF BIRTH STATE ZIP VOTER REGISTRATION VUID NUMBER (Opt iona l) JJb IN STATE $'Qyea r(s) month(s) IN TERRITORY FROM WHICH THE OFFICE SOUGHT IS ELECTED 3 c:;J year (s) month(s) If usin g a nickname as part of you r name to appear o n the ballot, you are a lso sign in g and swea rin g to the following statements: I further swear that my nickname does not const itute a slo ga n nor does it indi cate a political, eco nomic, soc ia l, o r religious view o r affili ati on. I have been commo nly known by this nickname for at least three years prior to this election. Before m e, the und e rsig ned autho rity, o n this day personally appeare d (n ame ) '1)e~/'-'"-._r /h!tlo N /7',_Y, who being by me here and now duly sworn, upon oat h says : (? "I, (n ame ) m11-1~,N:i;r , of p / ,4-7.--v./ County, Texas, being a ca ndid ate for the office of , swear that I will suppo rt and d efend t he Const itut ion and laws of the United States and of the State of exas. I am a citizen of t he United States e li gib le to hold su ch office under t he const itut ion and laws of t hi s st ate. I have not been finally conv icted of a felony for which I have not been pardoned or had my full rights of citizensh ip restored by other uffiLia l ac lion . I have not be en determined by a final judgment of a cou rt exerci sin g probate jurisdiction to be totiJ lly mcntiJlly inciJpacitated or partially mentally incapacitated without the r ight to vote. I am awa re of the nepotism law , Chapter 573, Governm e nt Code. I further swear that the forego in g statements includ ed in my a ppli cat io n are in all t hin gs t ru e and correct." x gNA~ TO BE COMPLETED BY CITY SECRETARY OR SECR o/RY OF BOARD: (See Sect ion 1.007 ) --/ 9 --.J_( Voter Registration Status Verified ~ Date Rece ived LISAF.~KEN Notary Public • State of Texas 10# 13297020-3 Comm. Expires 3·11·2025