HomeMy WebLinkAbout150714 - Candidate Application - John Nichols AW2.1 i,7/201 1
Prescribed by Secretary ol'State
Sections 141 031,143.004,143,006,Texas Election Code
All information is required to be provided unless indicated as optional
APPLICATION FOR A PLACE ON THE CITY OF re ll eqe 1�-ra-0A.� 7V GENERAL ELECTION BALLOT
TO:City Secretary
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
1, / Z� �?�C'� / 1 �L �' � Fl1I.I. UNEXPIRED
I
FULL.NAMF.(First,Middle,Last) PRINT NAME AS YOU WANT IT TO APPEAR ON TI IF BALLOT
PERMANENT RESIDENCE.ADDRESS (Street address and apartment MAILING ADDRESS(If dillerent from residence address)
number. if none, describe location of residence. Do not include P.O.
Box or Rural Rt.)
CITY STATE ZIP CITY STATE 'LIP
EMAIL ADDRESS(Optional) OCCUPATION(Do not leave blank) DATE.OF BIRTH VOTER REGISTRATION V1 ID N11;1v1BFR
TEI.EPIIONE NUMBER(Include area code)(Optional) Length of Continuous Residence as of Date Application Sworn
OFFICE: INSTATE IN CITY IN DISTRICT OR PRECINCT'
�
j(7 II10S IIIOs _MOS
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 relitious view or affiliation. I have
been commonly known by this nickname for at least three years prior to this election.
� yy /
Before me,the undersigned authority,on this day personally appeared(name) .� 0kh �• �� I Grls/S who being by me
here and now duly stvoru, upon oath says: "I, (name) . 'o G1 f1 R 14 of[;j/g STa /
County,Texas,being a candidate for the office of C.'/'f(I C o tom...:( , iv I cam L� swear that 14,
suprfort and
defend the Constitution and laws of the United States and of the State ofTeaas.I am a citizen of the United States eligible to hold such office under
the Constitution and laws of this state. I have not 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. 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 further swear Drat the foregoing statements included in my application are in all things ttu?1JRE
ct." �_
_ _ _ _ _
_ TANYA MCNUTT .. � )
* * Notary Public State of Texas �ZMy Commission Expires ) S((GNF CANDIDATE
Sworn to antl•sut3�crit5ed 6eltlle me at # Q (�,this the y day of 2-0 {5
SEAL
C—,-g.tur of Offi#administering oath' Title of Offlcer,Lp�iministering oath
TO BE COMPLETED BY CITY SECRETARY: L/ ZI�
(See Section 1.007) O �
Date Pkceived Signature of itv ecrttary
Texas Ethics Commission P.O.Box 12070 Austin,Texas 78711-2070 (512)463-5800 (TDD 1-800-735-2989)
APPOINTMENT OF A CAMPAIGN TREASURER FORM CTA
BY A CANDIDATE PG 1
See CTA Instruction Guide for detailed instructions. 1 Total pages filed:
--................ -
2 CANDIDATE MSIMRS/h4R f FIR,
I O MI OFFICE USE ONLY
NAME M P'• �� L�t`T ` `� i '
Accl N
MCKNAME LAST SUFFIX
Date Rece ved
3 CANDIDATE ADDRESS/PO BOX, AP1T!SUITE#.
4 CANDIDATE AREA CODE. PHONE NUMBER EXTENSION Date Hand-delivered orPostina.k✓ed
PHONE
Date Processed
5 OFFICE �� Date Imaged
Hay° ��'� �' o Cl --� ��c' q
6 OFFICE /1 /
SOUGHT �-
(if known)
7 CAMPAIGN MSIMRS/MR FIRST MI NICKNAME LAST SUFFIX
TREASURER NAME ) n
5
8 CAMPAIGN STREET ADDRESS(NO PO BOX PLEASE). APT!SUITE k, CITY; STATE; ZIP CODE
TREASURERSTREET /�
9 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE (
10 CANDIDATE /
SIGNATURE I am aware of the Nepotism Law, Chapter 573 of the Texas Government Code.
I am aware of my responsibility to file timely reports as required by title 15 of
the Election Code.
I am aware of the restrictions in title 15 of the Election Code on contributions
fr7' s
ns and 10 r organizations.
ature of Candidate Y Date Signed
GO TO PAGE 2
www.ethics.state.N.us Revised 0711 4/201 0
CITY OF COLLEGE STATION
Home of Texas A6-M University'
Candidate Authorization Form to Release E-Mail Address
Candidate for the November 3, 2015 City of College Station General Election.
Candidate Name: 0 H Kk �I i C,� 1 C) L
➢ On the "Application for a Place on the General Election Ballot" form, there is a box to
list the candidate's e-mail address.
➢ Listing the e-mail address is indicated as an optional item to fill out. The City Secretary
will use e-mail to contact Candidates so it would be helpful to include this information.
➢ The application is subject to open records under the Public Information Act; however,
personal e-mails are considered confidential.
By signing this acknowledgment form, the candidate is indicating their approval to release their
e-mail address should they include it on the application form. If the Candidate does not want
their e-mail address released, the City Secretary will redact that information before posting to the
City's website or releasing to any requestors.
Acknowle and Approved to release:
Signa of Candidate
t
Date: 1_ 1-, ,
Sherry Mashburn
From:
Sent: Monday, July 27, 2015 8:06 AM
To: Sherry Mashburn; Tanya McNutt
Subject: Fw: Election Filings 2015, Nichols
Attachments: Filing Application 2015 - John Nichols.pdf;Appointment of Campaign Treasurer- 2015
John Nichols.pdf
Sherry and Tanya,
Please confirm you have received this. If there are any problems I will take care of it tomorrow.
John
Sent from my BlackBerry 10 smartphone on the Verizon Wireless 4G LTE network.
From: John Nichols <
Sent: Wednesday, July 15, 2015 9:57 PM
To:
Subject: Election Filings 2015
Attached.
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