HomeMy WebLinkAbout210719 -- David Levine -- Candidate ApplicationRECEIVED
J LJ L 1 9 2 0 2 J Prescribed by Secretary of S~~~!
0 , 1 t'J f\C.. Secti n 141.031, Chapters 143 and 144, Texas Election Cod e
D .. ::.r1 if/ 1;2011
ALL INFORMATION IS REQUIRED TO BE PROVIDED UNLESS INDICATED OPTI i&\Y : ............................. .
APPLICATION FOR A PLACE ON THE November, 2nd 2021 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
College Station City Council, Place 6
FULL NAME (First, Middle, Last)
David Scott Levine
[[]FULL
DuNEXPIRED
PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT 1
David Levine
PERMANENT RESIDENCE ADDRESS (Do not include a P.O. Box or Rural PUBLIC MAILING ADDRESS (Campaign mailing address, if available.)
Route. If you do not have a residence address, describe the address
at which you receive personal mail and location of residence.)
CITY
College Station
PUBLIC EMAIL ADDRESS (If available)
DATE OF BIRTH
STATE ZIP
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
Work:
Cell : (
_lL year (s)
_l _ month(s)
OFFICE SOUGHT IS ELECTED 3
_8_year(s)
__!!_ 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) David Scott Levine
here and now duly sworn, upon oath says :
, who being by me
"I, (name) David Scott Levine of Brazos county, Texas, being a
candidate for the office of College Station City Council, Place 6 , swear that I will support and defend the Constitution and laws
of the United States and of the State of Texas. I am a citizen of the United States eligible Lo hold such office under Lhe 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 that the foregoing statements included in my application are in all things true and correct ."
(See Section 1.007)
Voter Registration Status Verified ~ Date Received