HomeMy WebLinkAbout240722 -- Application for Place on Ballot -- David White2.49
Prescribed by Secretary of State
Section 141.031, Chapters 143 and 144, Texas Election Code
09/2023
APPLICATION FOR A PLACE ON THE BALLOT FOR A GENERAL ELECTION
FOR A CITY, SCHOOL DISTRICT OR OTHER POLITICAL SUBDIVISION
RECEIVED
JUL 221024c-
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ALL INFORMATION IS REQUIRED TO BE PROVIDED UNLESS INDICATED AS OPTIONAL' Failure to provide requlred Information may result In rejection of application.
APPLICATION FOR A PLACE ON THE ON-4 t. 0 \ t-f- GT15 GENERAL 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.)
CQi1 GC; STATICK CcTy emu►-+cl ( — t�1Ae� 3
INDICATE
TERM n
FULL I 1 UNEXPIRED
FULL NAME (First, Middle, Last)
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PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT*
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PERMANENT RESIDENCE ADDRESS (Do not include a P.O. Box or Rural Route. If
you do
ADDRESS (Optional) (Address for which you receive
campaign related correspondence, If available.)
`I - sy
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STATE
ZIP
7 Lis
CITY
c13LLe-GL` STi}T-1 iO
STATE
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ZIP t c
7-7 8'f5
PUBLIC EMAIL ADDRESS (Optional) (Address for
which you receive campaign related emails, if available.)
OCCUPATION (Do not leave blank)
r etcl eT' % C o
Pr
DATE OF BIRTH
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VOTER
NUMBER2 (Optional)
TELEPHONE CONTACT INFORMATION (Optional)
Home: Office: Cell:
FELONY CONVICTION STATUS (You MUST check one)
LENGTH OF CONTINUOUS RESIDENCE AS OF DATE THIS APPLICATION WAS SWORN
V I have not been finally convicted of a felony.
❑ 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.3
IN THE STATE OF TEXAS
year(s)
IN TERRITORY/DISTRICT/PRECINCT FROM
WHICH THE OFFICE SOUGHT IS ELECTED
S year(s)
3 month(s)
3 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 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) 004 t 0 tip;'r (Te' , who
being by me here and now duly sworn, upon oath says:
"I, (name of candidate) (Q A'4 t 0 UJ N t -T-L-- , of 14 r• a WS County, Texas,
being a candidate for the office of L S C-tT`f COON -LC k. t - (- f CC 3 , 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 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 that knowingly providing false information on the application regarding my possible felony conviction
status constitutes a Class B misdemeanor. I further swear that the foregoing sta ents included in my application are in all things true and correct."
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SIGNATURE OF CANDIDATE
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Sworn to and subscribed before me this the 10 n. day of S , .-90 , by )t d %.li-c_• •
(day) (mo th) (yeark
iri“.:-(jilt .E�✓' AG+..F4-t4
(name of candidate)
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Sign ture o Officer Authorized to Administer Oath° Print
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Notary Public
STATE OF TEXAS i
Title of Officer Authorized to Administer Oath
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My Comm. Exp. 04-10-25
TO BE COMPLETED BY FILING OFFICER: THIS APPLICATION IS ACCOMPANIED BY T
R = ` ', I I Vk 'iz I r 'ifbiteaft) P ID BY:
❑ CASH ❑ CHECK ❑ MONEY ORDER ❑ CASHIERS CHECK OR ❑ PETITION IN LIE
This document and $ D filing fee or a nominating petition of pages received.
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E-QVoter Registration Status Verified
07 / 2.2 / 2OZ51 0 7 / 22 / ZOZ't (See Section 1.007) C4..QGY!
Date Received Date Accepted Sign re of 1 ' ing Officer or Designee