Mays, Wes-AP 2020-01-15 I
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. ice-`( o F Cc?PEIL- 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
C I T Y CC' v` 14C,\ L ) P L P,CE UNEXPIRED
FULL NAME(First,Middle,Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT'
\i /2 \e 1\111 00V\ M&yc We S May s
PERMANENT RESIDEN{eE ADDRESS(Do not include a PAD.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.)
142 ,_, ,,,. . Per C_±
CITY ' STATE ZIP CITY STATE ZIP
CP > tii, 1.-x 7Sotot („tppELL 7-x 75019
PUBLIC EMAIL ADDRESS(If available) OCCUPATION(Do not leave blank) ( DATE OF BIRTH • VOTER REGISTRATION VUID
NUMBER(Optional)'
LI t,c.ra_ YAP q p MSN,cowt ENG/A E2 /
) 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: II
year(s) year(s)
Cell: 3 month(s) 3 month(s)
If using a nickname s 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) Vies N S I"\el ,who being by me
here and now dulylsworn,upon oath says:
"I, (name) l/V e-S 1 sa`ys`Q'( S of Pc t- .V S County, Texas, being a
candidate for the office of C-0p pe�\' C Z4-1 C-O ur1C-A( ,swear that I will support arid 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 correct."
�
X L/�Jlt
SIGNATURE OF CANDIDA E
Sworn to and subscribe' .efore me at Sr— '00 AKA ,this t itTe—rghl day of ,_. C2Q –
C l 4o``arn" SRBMLEY M. OWENS
?z°. '� ��,:Notary Public,State o`Texas
/�•i 0 / CI �-�C_C Cz.�= 1:-.2..^2.,. 'c1 Comm. Expires 02-24-2023
Signature of Offi - Administering Oath' ^ _ Title of Off! r Admin' ening Oath �'� °F�`� Notary ID 130128928
TO BE COMPLETM BY CITY SECRETARY OR SECR TARY OF BOARD:
(See Section 1.007) JD ttAtr 'S/20,O \: !. -_ . A_• I ---
A
Date Received Signature of Secreta
Voter Registration Status Verified � _ — .