HomeMy WebLinkAbout210816 -- Marie-Anne Mousseau-Holland -- Candidate ApplicationR .ECEIVED
ALL INFORMATION IS REQUIRED TO BE PROVIDED UNLESS INDICATE
APPLICATION FOR A PLACE ON THE Cc. v'('\,c_.\ \ .
TO : City Secretary/Secretary of Board
2-21
Prescribed by Sec retary of St at e
Section 141.031, Chapters 143 and 144, Texas Election Code
1/2017
GENERAL ELE CTION BALLOT
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
G ·~ Lo v t'\ c, : \ \:> l a..e e, !Stu LL Lt D UNEXPIRED
FULL NAME (First, Middle, Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT 1
/\flo u ~s
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.) · ·~
{-., Su1"\-e '"Z.0-3 8
STATE ZIP CITY
17
PUBLI~ EM~L ADDRESS {If available) OCCUPATION (Do not leave blank) DATE OF BIRTH
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STATE ZIP
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VOTER REGISTRATION VUID
NUMBER (Optional) 2
TELEPHONE CONTACT INFORMATION {Optional) LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN
Home : ~ IN STATE IN TERRITORY FROM WHICH THE
.....-OFFICE SOUGHT IS ELECTED 3
Work: 1o_ year(s) 13_ year(s)
Cell: '}_\ -12_ month(s) _Q_ month(s)
If using a nickname as part of you r 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) {)fl cl r \ e -G. 0 n e Ho I\ <w d 'who being by me
here and now duly sworn, upon oath says :
"I, (name) MM\ t {~xW\..C, \\o u ~Vl c\ ' of 3-r c,,;-z. Cl') Ce u ,, ·~~ County, Texas, being a
candidate fort.he office of (' '· t ~ <:.G v V\ C.i l . 'f \ e ... ( -t (., , swear that I will supp and defend the Co~sti~ution and laws
of the United States and of the Stat of Texas . I am a c1t1zen of th e Uni t ed St ates eligible to hold such office under the conslllul1un 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 thing
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TO BE COMPLETED BY CITY SECRETARY OR SECRET?Y OF BOARD:
(See Section 1.007) ~·-I lo -..OD~I
/ Date Received
Voter Re gistration Statu ~ Verified litr
ISA F. MoQRACKEN
Nota ry Pub!i r. • State of Texas
ii.)# 1329 702 '-1 ·3
M Comm. Expires :l · 1 l ·2025