Long, Cliff-AP 2020-01-15 2-21
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 C,,°#' t,L e ry Co LA A/LI t—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.) IN�D,IICCATE TERM
C"/C"/9(1.2'4'i 7--'4 C f4rri C0CI,✓C/L. , g-14<4.- �+� / /-FULL
UNEXPIRED
FULL NAME(First, Middle, Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT'
#4vR9 dl,FFo2o me/4 CZ/1'P- 40.7e,
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.) 44.5"/7L,44.5"/7L, �Oq.S/oA/ 1r tE€J--
7/r� Boum- OvPP4w4-. K ,41L C70/10/C't'L1 --77EV ks 75,0/9
C.oPP/ft L., 7 F5eits 76"0/9
CITY STATE ZIP CITY STATE ZIP
OoP e:t_4. 1,C 75-4i q (20 POe«— T 7,S0/ ?
PUBLIC EMAIL ADDRESS(If available) OCCUPATION(Do not leave blank) DATE OF BIRTH VOTER REGISTRATION VOID
p NUMBER(Optional)2
a10n/c e„ppe iIN14 • 70✓ 04.„„4.4.!/Yt,4•✓/f-GE2-_ ///
TELEPHONE CONTACT INFORMATION(Optional) LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN
Home: IN STATE IN TERRITORY FROM WHICH THE
OFFICE SOUGHT IS ELECTED3
Work:
7qyear(s) year(s)
Cell:
2- month(s) month(s)
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) r t✓A-Ct e4otzF0RA IvB4/4 ,who being by me
here and now dulysworn, upon oath says: 1
"I, (name) /1/#//R/ &/1 e,A.6 W An/G , of _1)4-LLA3 County, Texas, being a
candidate for the office of C oPP,Sta C'Fci 00t /c t i-- PLiicp .(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 a I things true and correct."
X4.., ,, Q., .
,` SIGNATURE OF CAND
Sworn to and subscribed before me at �•4k/l ,this the /541 rday ofQdri ,Lin
20 _r
•~ � i,pYpV,/i ASHLEY M. OWENS Ir
/�� ` _ C .. B�?Notary Public,State of Texas
4 'P Comm.Expires 02-24-2023
Signature of Officer A. .nistering Oath Title of Office .1.ministerii• Oa ; =SAF ;; 130128128
,,,,,,,, Notary ID
TO BE COMPLETED B t ITY SECRETARY OR SECRkTARY OF BOARD: ... ��
(See Section 1.007) "vlatlll 16,2020 . A
1
Date Recei Signature of ecretary
Voter Registration Status Verified L