HomeMy WebLinkAbout240816 -- Application for Place on Ballot -- Scott Shaferwhic
h you receive campaign related emails, if available.)
TELEPHONE CONTACT INFORMATION (Optional)
Home: Office:
FELONY CONVICTION STATUS (You MUST check one)
❑✓ 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
2-49
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
ALL INFORMATION IS REQUIRED TO BE PROVIDED UNLESS INDICATED AS OPTIONAL' Failure to provide required information may result in rejection of application.
APPLICATION FOR A PLACE ON THE College Station November 5, 2024 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.) INDICATE TERM
City Council Place 6
FULL NAME (First, Middle, Last)
Carl Scott Shafer
PERMANENT RESIDENCE ADDRESS (Do not include a P.O. Box or Rural Route. If
you do not have a residence address, describe location of residence.)
CITY
College Station
STATE
TX
FULL J UNEXPIRED
PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT*
Scott Shafer
PUBLIC MAILING ADDRESS (Optional) (Address for which you receive
campaign related correspondence, if available.)
ZIP CITY
77840 College Station
PUBLIC EMAIL ADDRESS (Optional) (Address for I OCCUPATION (Do not leave blank)
DATE OF BIRTH
STATE
TX
ZIP
77840
VOTER REGISTRATION VUID
1040978831
Cell: (979) 229-9111
LENGTH OF CONTINUOUS RESIDENCE AS OF DATE THIS APPLICATION WAS SWORN
IN THE STATE OF TEXAS I IN TERRITORY/DISTRICT/PRECINCT FROM
WHICH THE OFFICE SOUGHT IS ELECTED
28 28 year(s)
year(s)
9 month(s) 9 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 I
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) Carl Scott Shafer , who
being by me here and now duly sworn, upon oath says:
"I, (name of candidate) Carl Scott Shafer
being a candidate for the office of City Council Place 6
Sworn to and subscribed before me this the
RECEIVED
AUG 16 2024
KA,
12:zorm
of Brazos County _ County, Texas,
, 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 statements included in my application aren all things true and correct."
SIGNATURE OF CANDIDATE
202.14 .by_ ri
(year)
(day)
Signature of OffiakrAuthorizedto Admiis`r Oath4
Title of Officer Authorized of Administer Oath
day of
(month)
e c 114 5rir
(name of candidate)
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`• = Comm. Expires 02-27-2027
fftE;S�,,. O'Notary-ID 13178397-0
TO BE COMPLETED BY FILING OFFICER: THIS APPLICATION IS ACCOMPANIED BY THE REQUIRED FILING FEE (If Applicable) PAID BY:
0 CASH ❑ CHECK ❑ MONEY ORDER ❑ CASHIERS CHECK OR ❑ PETITION IN LIEU OF A FILING FEE.
This document and $ filing fee or a nominating petition of pages received. Voter Registration Status Verified
(See Section 1.007)
Date Received Date Accepted
Signature of Filing Officer or Designee