210719 - Candidate Application - Dennis MaloneyALL INFORMATION IS REQUIRED TO BE PROVIDED UNLESS IN
RECEIVED
JUL l .-' l\J I 2-2 1
Prescr ibed by Secretary of State
Sectio n 141.03 1, Chapters 143 and 144, Te xas Elec ti o n Code
1/2017
APPLICATION FOR A PLACE ON THE __ __."""--!-......._+-__,.,"""-"'-=<--=-~_,__--GENERAL ELECTION BALLOT
TO: City Secretary/Secretary of Board
I request that my name be placed on the above-nam ed official ballot as a ca ndid ate for the office indi cated below.
OFFICE SOUGHT (Inclu de any place number or other distinguishing number, if any.) INDIC,ATE TERM O/q / gULL v I, e (/ Du NE XP IRED
FULL NAME (Fir st, Middle, Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT 1
J>e~ µ,·./ ve;v,.u1.:r
PERMANENT RESIDENCE ADDRESS (Do not in clud e a P.O. Box or Rural PUBLIC MAILING ADDRESS (C ampaig n mailing aadress, if ava il ab le .)
Route. If you do not have a residence address, describe the ad
at qcJoJ ~cee;;;;il i;~:es id e n ce .) / ~
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CITY STATE ZIP
C.1-
PUBLIC EMAIL ADDRESS (If ava il ab le)
TELEPHONE CONTACT INFORMATION (Opti ona l)
Hom ff
W ork :
Ce ll:
CITY
DATE OF BIRTH
STATE ZIP
VOTER REGISTRATION VUID
NUMBER (Opt iona l)
JJb
IN STATE
$'Qyea r(s)
month(s)
IN TERRITORY FROM WHICH THE
OFFICE SOUGHT IS ELECTED 3
c:;J year (s)
month(s)
If usin g a nickname as part of you r name to appear o n the ballot, you are a lso sign in g and swea rin g to the following statements: I further swear
that my nickname does not const itute a slo ga n nor does it indi cate a political, eco nomic, soc ia l, o r religious view o r affili ati on. I have been
commo nly known by this nickname for at least three years prior to this election.
Before m e, the und e rsig ned autho rity, o n this day personally appeare d (n ame ) '1)e~/'-'"-._r /h!tlo N /7',_Y, who being by me
here and now duly sworn, upon oat h says : (?
"I, (n ame ) m11-1~,N:i;r , of p / ,4-7.--v./ County, Texas, being a
ca ndid ate for the office of , swear that I will suppo rt and d efend t he Const itut ion and laws
of the United States and of the State of exas. I am a citizen of t he United States e li gib le to hold su ch office under t he const itut ion and laws of
t hi s st ate. I have not been finally conv icted of a felony for which I have not been pardoned or had my full rights of citizensh ip restored by other
uffiLia l ac lion . I have not be en determined by a final judgment of a cou rt exerci sin g probate jurisdiction to be totiJ lly mcntiJlly inciJpacitated or
partially mentally incapacitated without the r ight to vote. I am awa re of the nepotism law , Chapter 573, Governm e nt Code.
I further swear that the forego in g statements includ ed in my a ppli cat io n are in all t hin gs t ru e and correct."
x gNA~
TO BE COMPLETED BY CITY SECRETARY OR SECR o/RY OF BOARD:
(See Sect ion 1.007 ) --/ 9 --.J_(
Voter Registration Status Verified ~ Date Rece ived
LISAF.~KEN
Notary Public • State of Texas
10# 13297020-3
Comm. Expires 3·11·2025