210719 -- William Wright -- Application for Place on BallotRECEIVED
2-2 1
Presc ribed by Secre tary of State
Section 141.031, Chapters 143 and 144, Texas Ele ction Code
1/2017
ALL INFORMATION IS REQUIRED TO BE PROVIDED UNLESS INDICATED
APPLICATION FOR A PLACE ON THE _/J_o _v _._z_"'"_t _'.:J:.~~~j::::::::::::::_:::::~-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
IKJFULL
DuNEXPIRED
FULL NAME (First, Middle, Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT 1
PERMANENT RESIDENCE ADDRESS (Do not include 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 STATE ZIP CITY
lo 1116 -. 5/,, h:V'? I( , J 1 i' 'IS-
PUBLIC EMAIL ADDRESS (If available) OCCUPATION (Do not l eave blank) DATE OF BIRTH
w..,..'1"'-M ~;( -i.' t.~wi~ .. l,.,..._ 1t' s ..,. 'f Plfl>kk~ Sv~~"""'
STATE
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ZIP
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VOTER REGISTRATION VUID
NUMBER (Optional) 2
TELEPHONE CONTACT INFORMATION (Optional)
Home:
LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN
IN STATE IN TERRITORY FROM WHICH THE
OFFICE SOUGHT IS ELECTED 3
Work: ~ 'l.. year (s) "'!> 1. year (s)
Cell: ' \ '"'~month (s) -1!_ 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) W1 '/I ,·14.""'-k)..,) l t
here and now duly sworn, upon oath.says :
, who being by me
"I, (name) (A_)\I (,,.,"" {,J.....,_)"'-. f-, of ~~ S County, Texas, being a
candidate for the office of C.C,I()<-51-b (, 1 ~. ·1 Pl~c.. "t , swear that I will'support and defend the Constitution and law s
of the United States and of the State of Texas. I am a citizen of the United Stat es eligib le to hold suc:h office under the con stitution anrl lriws of
this state. I have not been finally convicted of a felony for which I have not been pardoned or had my ful l rights of citizen ship r estor ed by other
official action. I have not been determined by a final judgment of a court exercising probate jurisdiction to be totally mentally incapa citated 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 in all thing~e an 1correct." ~ . x //
Sworn to and subscribed before me at \ . Q 6 p VY\
Signature of Officer Administering Oath4 Title of Off1
TO BE COMPLETED BY CITY SECRETARY OR SECREl/~RY OF BOARD:
(See Section 1.007 ) 06-0~-:J.o:i.,/
Voter Registration Status Verified M Date Received