Hinojosa-Flores, Brianna-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 OPTIONAL
APPLICATION FOR A PLACE ON THE Q 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 distinguishin/g� number, if any.)
Gow 1` Ck-
INDICATE TERM
ULL
�or"other
V�1�v\l.11 � I uC� �
UNEXPIRED
FULL NAME (First, Middle, Last)
PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT'
Ir, Q�� a. L . VV os � I � �
�r ; a�� �, f\ V \ os - I- l �r� s
PERMANENT RESIDENCE ADDRESS (Do not ihAde 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.)
-1`J O
��1, � � • ►� sem, R
no
CITY
STATE
ZIP
CITY
CITY
r
�
STATE
ZIP
IP
:n�
C O
sb)
PUBLIC EM I ADD ESS (If available)
OCCUPATION (Do not leave blank)
DA E OF BIRTH
VOT R REGISTRATION VUID
NUMBER (Optional) 2
Ilw,�,�.
10 335
TELEPHONE CONTACT INFORMATION (Optional)
LENGTH`lliOF CONTINUOUS RESIDENCE
AS OF DATE APPLICATION SWORN
Home: k)
IN STATE
IN TERRITORY FROM WHICH THE
OFFICE SOUGHT IS ELECTED
Work:
year (s)
year (s)
Cell:
(O month(s)
y months)
If using a nickname as partof 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.
r
Before me, the undersigned authority, on this day personally appeared (name) ��\QV�II��I X11 �� "1 oI , who being by me
here and now duly sworn, upon oath says:
"I, (name) C �S V"t-10 of —��1�� �� County, Texas, being a
candidate for the office of Qt -C _Z,— swear that I will support and defend the Constitution and laws
of the United States and of the ate of Texas. I am a citizen f Thp 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
.6 1SIG A RE OF CANDIDATE
S orn to and subscribed before mea , this the _ ay JA I%—
.. � JEAN NELL
Notary 76603
My Commission Expires
Il June 20, 2021
ignature of Officer Administering Oath° Title of Office Admi s r' g Oath
TO BE COMPLETED BY CITY SECRETARY OR SECRETA Y OFOARD: ,
(See Section 1.007)
Date ecei ed ture of Secretary
Voter Registration Status Verified