Bitter, Aaron-AP 2018-02-162-21
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/ Or 415'-4-C GENERAL ELECTION BALLOT
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TO: City Secretary/Secretary of Board y 1—'
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 placeor other distinguishing number, if any.)
IND�TERM
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COVIVC1Z PL�C� 6
FULL
❑ UNEXPIRED
FULL NAME Last)
PRINT NAME AS YOU WANT IT TO APPEAR ON THEBALLOTl
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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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PUBLIC EMAIL ADDRESS (If available)
OCCUPATION (Do not leave blank)
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DATE OF BIRTH
VOTER REGISTRATION VUID
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.
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Before me, the undersigned authority, on this day personally appeared (name)_ _ 10-1-10-1-04-RW'4pj - C n , who being by me
here and now duly sworn, upon oath says:
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(name) 6yy LR r%na of D�T�-> County, Texas, being a
candidate for the office of C-177 ftWC jM –_ RkA cE 6 swear that I will support and defend the Constitution and laws
of the United States and of the State 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."
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Th SIGNATURE OF C
S n to and subscribed fore me at this the day of CNRISTEL B PETTING
MMmmisslon Ellpit
Zolzh May 10, 2019
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nature of Officer A ministering Oath Title ofAce r Ad nit ring
TO BE COMPLETED BY CITY SECRETARY OR SECREALJJY OF CARD: ,
(See Section 1.007) L
Date eceiv gnature of Secreta
Voter Registration Status Verified L�