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HomeMy WebLinkAbout260813 -- Application for a Place on Ballot -- Valen Cepak2-50 Prescribed by Secretary of State Section 141.031, Chapters 143 and 144, Texas Election Code; Section 11.055, Texas Education Code 07/2025 RECEIVED AUG 1 3 2076 APPLICATION FOR A PLACE ON THE BALLOT FOR A SPECIAL ELECTION G FOR A CITY, SCHOOL DISTRICT OR OTHER POLITICAL SUBDIVISION -1 '345 P"^ ALL INFORMATION IS REQUIRED TO BE PROVIDED UNLESS INDICATED AS OPTIONAL' Failure to provide required information may result in rejection of application. APPLICATION FOR A PLACE ON THE Co)) e 3 4- .-STD-4',cn SPECIAL ELECTION BALLOT TO: City Secretary/Secretary of Board (name of election) 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.) r (CO) G e•-SLan 4,an Ct �/ CD,cr FULL NA11(First, Middle, Last) \/, GE n/ C E p t/. PERMANENT RESIDENCE ADDRESS (Do not include a P.O. Box or Rural Route. If you do not have a residence address, describe location of residence.) 3a) Cam)) e— STATE WC. ZIP 7 7o INDICATE TERM FULL II UNEXPIRED PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT* PUBLIC MAILING ADDRESS (Address for which you receive campaign related corresspponnddeenn e, if available.) 6V1 CITY PUBLIC EEM,A/ILLAADDRESS (Address sffor �which %you /- tOC/C/U�PATIOnrN (Do not leave blank) rV�lTie t (�tV1/ails,ifav�iWI*v C.Ct v v1s J , r TELEPHONE CONTACT INFORMATION (Optiona ) Home: FE NY CONVICTION STATUS (You MUST check one) I have not been finally convicted of a felony. Ell I have been finally convicted of a felony, but I have been pardoned or otherwise released from the resulting disabilities of that felony conviction and I have provided proof of this fact with the submission of this application.' Office: STATE ZIP DATE OF BIRTH VOTER REGISTRATION VUID NUMBER2 (Optional) Cell: ` -zr7` OF CONTINUOUS RESIDENCE AS OF DATE THIS APPLICATION WAS SWORN IN THE STATE OF TEXAS IN TERRITORY/DISTRICT/PRECINCT FROM WHICH THE OFFICE OUGHT IS ELECTED Z /-7 year(s) year(s) ) 1 month(s) month(s) This Box Must ONLY be Completed by Candidates for School District Board of Trustees Check the Box Below: ❑ I am aware that I am not eligible to serve as a trustee of an independent school district if I am required to register as a sex offender under Chapter 62, Code of Criminal Procedure. *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 or contain a title, 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. Please review sections 52.031, 52.032 and 52.033 of the Texas Election Code regarding the rules for how names may be listed on the official ballot. Before me, the undersigned authority, on this day personally appeared (name of candidate) V r 1 t-CiN cAtti, , who being by me here and now duly sworn, upon oath says( /,. , , / (� �� r "I, (name of, a,nc(idate) `� /`� \Y @F , of 1 �^ Z 0 < County, Texas, being a candidate for the office of (� r 4 -1 Co./' h L , v K- , swear that I will support and defend the Constitution and laws of the United States and of the State of Texas. I am a citizeA of the United States el ible to hold such office under the constitution and laws of this state. 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 am aware that I must disclose any prior felony conviction, and if so convicted, must provide proof that I have been pardoned or otherwise released from the resulting disabilities of any such final felony conviction. I am aware th n ingly providing false information on the application regarding my possible felony conviction status constitutes a Class B misdemeanor. I further swe ha a fgri oing statement] udin j putts -are in all things true and correct." X bscribed before me this the R41*"day of (day) Signature ofcer Authorized to Administer Oath4 Pc41C'a�P , >-4 Title of Officer Aul(horized to dminister Oath / TO BE COMPLETED BY FILING OFFICER: THIS APPLICATION IS ACCOMPANIED BY THE REQUIRED FILING FEE (If Applicable) PAID BY: CASH 0 CHECK ❑ MONEY ORDER ❑ CASHIERS CHECK OR EI PETITION IN LIEU OF A FILING FEE. 7't nonth) SIGNATURE , by This document and $ filing fee or a nominating petition of trrxma of ranrjidate) AtjWHITT TO oMY COMM EXP.6/0p/29 ii ster Oath NOTARY ID 129465522 pages received. Voter Registration Status Verified 0 / /J ,20X OS / l4 / 2024 (See Section 1.007) Date Received Date Accepted Signatu e of Rung Officer or Designee 2-50 Prescribed by Secretary of State Section 141.031, Chapters 143 and 144, Texas Election Code; Section 11.055, Texas Education Code 07/2025 INSTRUCTIONS A special election can be used to fill a vacancy only if authorized by law. An application for a special election may not be filed until after the election is ordered. The filing deadline is governed by Section 201.054 of the Texas Election Code, and by the date the special election was ordered. The filing deadline should be stated in the election order. Please review the Secretary of State's current election law calendars for Section 201.054 deadlines. If you have questions about the application, please contact the Secretary of State's Elections Division at 800-252- 8683. NEPOTISM LAW The candidate must sign this statement indicating his awareness of the nepotism law. When a candidate signs the application, it is an acknowledgment that the candidate is aware of the nepotism law. The nepotism prohibitions of chapter 573, Government Code, are summarized below: No officer may appoint, or vote for or confirm the appointment or employment of any person related within the second degree by affinity (marriage) or the third degree by consanguinity (blood) to himself, or to any other member of the governing body or court on which he serves when the compensation of that person is to be paid out of public funds or fees of office. However, nothing in the law prevents the appointment, voting for, or confirmation of anyone who has been continuously employed in the office or employment for the following period prior to the election or appointment of the officer or member related to the employee in the prohibited degree: six months, if the officer or member is elected at an election other than the general election for state and county officers. No candidate may take action to influence an employee of the office to which the candidate is seeking election or an employee or officer of the governmental body to which the candidate is seeking election regarding the appointment or employment of a person related to the candidate in a prohibited degree as noted above. This prohibition does not apply to a candidate's actions with respect to a bona fide class or category of employees or prospective employees. FOOTNOTES 1An application for a place on the ballot, including any accompanying petition, is public information immediately on its filing. (Section 141.035, Texas Election Code) 'Inclusion of a candidate's VUID is optional. However, many candidates are required to be registered voters in the territory from which the office is elected at the time of the filing deadline. Please visit the Elections Division of the Secretary of State's website for additional information. 3Proof of release from the resulting disabilities of a felony conviction would include proof of judicial clemency under Texas Code of Criminal Procedure 42A.701, proof of executive pardon under Texas Code of Criminal Procedure 48.01, or proof of a restoration of rights under Texas Code of Criminal Procedure 48.05. (Texas Attorney General Opinion KP-0251) One of the following documents must be submitted with this application: Judicial Clemency under Texas Code of Criminal Procedure 42A.701 Executive Pardon under Texas Code of Criminal Procedure 48.01 Restoration of Rights under Texas Code of Criminal Procedure 48.05 4A11 oaths, affidavits, or affirmations made within this State may be administered and a certificate of the fact given by a judge, clerk, or commissioner of any court of record, a notary public, a justice of the peace, city secretary (for a city office), and the Secretary of State of Texas. See Chapter 602 of the Texas Government Code for the complete list of persons authorized to administer oaths.