CL AppAW2-15, 7/20] 1
Prescr~bed bv Secretary of State
Sect~ons 141 03 I, 143 004, 143 006, Texas Elect~on Code
All information is required to be provided unless indicated as optional
APPLICATION FOR A PLACE ON THE CITY OF C~P&LC GENERAL ELECTION BALLOT
TO: City Secretary
I request thal my namc be placed on the abo\e-namcd official ballot as a candidate fhr the office indicated belob.
OFITI~~ SOUGHT lncludeany placfiumber or other dklinguishing numb&. it, an). I TI: TERM
- 1 L.d FULL U IJNEXI'IRED
FUIl NAMI: (First, Middle, Last) 1 PRIN'I' NAME AS YOU WANT 11' 'r'O APP1:AR ON THE BAI,I.OT
CII'Y 1 STATli 1 ZIP 1 STATE I ZIP
PIil<hlANENT RESIDI'NCE ADDRESS (Street address and apartment
number. If none. dcscribe location of recidencc. Do not includc P.0. ox or Rural ~t.)
77l Cmcsrfied Cr
MAII.ING AI)I)I<ESS (Ifdifferent from residcnce address)
/dJ/ q SA?&DY &Me
1 750/9 1 I
OFFICE,: 972 - 373-1990 1 INS.I.ATE I IN CITY I IN DISTRICT OR PRECINCT^
&//ELL
&51dac~ OL/~~L
I EVECLL~~VE
Z mos S mos
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Before tnc. the undersigned authority. on this . irho being by me
here and now duly sworn. upon oath &AU&<
County, Texas; being a candidale for thc office of , swear that I \\ill support and
defend the Constitution and labvs of thc such oftice under
the Constitution and la\vs of lhis stale. I have not been finally convicted of a Ielony for which I have not been pardoned or had my full rights of
citizenship restored by other ofkid aclion. I have not bccn determined by a final judgment ol'a court cxercising probate jurisdiction to be totally
mcntally incapacitated or partially nlentally incapacitated without thc right to vote. I am abvart: of the nepotism law, Chapter 573. Government Code.
[':MAIL ADDRESS (Opt~onal) OCCIJI'ATION (Do not leave blanh) I DATI: OF BIR'I'H I VOTER REGISTRATION VIJlD NIJhlBER
/@g&
I f~rther swear that the foregoing statements includcd in my application are in all things true and correct." n
(if applicable)
/0876~?3/9
TELEPHONE NIJMBER (Include area code) (Optional)
,X~~-W~ SIGNAT II<E OF CANDIDATE
1,ength of Continuous Residence as of Date Application Sworn
TO HI': COMI'I>ETED BY ClTY SECRETARY:
(Sec Section 1 007)