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170724 - Candidate Application - John Nichols 2-21 Prescribed by Secretary of State Section 141.031,Chapters 143 and 144,Texas Election Code 1/2017 ALL INFORMATION IS RFQUIREP TO BE PROVIDED UNLESS INDICATED OPTIONAL APPLICATION FOR A PLACE ON THE 5i 1 'TX` GENERAL ELECTION BALLOT TO:City Secretary/Secretary of Board 1 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 UNEXPIRED FULL NAME(First, Middle, Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOTJel )�At 1900weW J OWN 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 STATE ZIP CITY STATE ZIP PUBLIC EMAIL ADDRESS(If available) OCCUPATION(Do not leave blank) DATE OF BIRTH VOTER REGISTRATION VUID NUMBER(Optional)z TELEPHONE CONTACT INFORMATION(Optional) LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN Home: CQ7[�� 6, 3 "�� / IN STATE IN TERRITORY FROM WHICH THE // 7 JJ / OFFICE SOUGHT IS ELECTED Work: C� A�T year(s) year(s) Cell: /0 month(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. l Before me,the undersigned authority,on this day personally appeared (name)® � /(�• G� / © !5 ,who being by me here and now duly sworn,upon oath says: "I, (name) 'Jo f O6, of dt d►� , �5 County, Texas, being a candidate for the office of C:4-q CV"_v_/ -PI c{6-e ,JJ swear that I will support and defend the Constitution and laws of the United States and of the Stale 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 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." X O_ SIGNATU •' Sworn to and subscribed before me at � c,.rn ,this the-QA day of •L.I A Z 1910YZSO�d § � Notary Public, ale Texas � my comrnission Expires \, /� n I * * April 17,2021 .. 1 Signature of Officer Administering Oath° Title of Officer A�Asg Oath J TO BE COMPLETED BY CITY SECRETARY OR SECRETARY[iF B A D: (See Section 1.007) 1 �0 I k c✓ � Date Received Signature of Secre ar Voter Registration Status Verified /Jut 31