Hunt, Karen-AP 2018-01-172-21
Prescribed by Secretary of State
Section 141.031, Chapters 143 and 144, Texas Election Code
1/2017
ALL INFORMATION IS REQUIRED TO BE PROVIDED UNLESS INDICATED OPTIONAI
APPLICATION FOR A PLACE ON THE 0-DODAt Onl I y1CA klaw 20l GENERAL ELECTION BALLOT
TO: City Secretary/Secretary of Board
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
FULL
1:1 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
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.)
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SAFE
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CITY
STATE
ZIP
CITY
STATE
ZIP
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PUBLIC EMAIL ADDRESS (If available)
OCCUPATION (Do not leave blanATE
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VOTER REGISTRATION VUID
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NUMBER(Optional)2
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TELEPHONE CONTACT INFORMATION (Optional)
LENGTH OF CONTINUOUS RESIDENCE
AS OF DATE APPLICATION SWORN
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IN STATE
IN TERRITORY FROM WHICH THE
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OFFICE SOUGHT IS ELECTED
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month(s)
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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.
Before me, the undersigned authority, on this day personally appeared (name) 12-A4?P-N < t LL& 14Qi T who being by me
here and now duly sworn, upon oath says:
"I, (name) 14v" J� (,( (�� ofDql �o�S County, Texas, being a
candidate for the office of D d (VAqA2ZA I swear that I will support and defend the Constitution and laws
of the United States and of the State of Tex . I am a citizYn of the nited 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 I .w, Chapter 573, Government Code.
I further swear that the foregoing statements included in my application are in all Ings tru and correct."
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SIGNU�LATURE
rn to and subscribed before me at this the ay of JFANDWINNELI
Notary IO�t4�6601
1).
/In My cowaftsion &Of*$
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UZ - r �. June 20, 2021
Sj nature of Officer Administering ath4 Title of Office Admi tering Oath
O BE COMPLETED BY CITY SECRETARY OR SECRET RY OF BOARD:
(See Section 1.007) n I Zo I gr (i
Date IRPrelived ignature of Secreta
Voter Registration Status Verified