Hinojosa-Smith, Brianna-AP 2021-01-132-21
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 Ot OC1Q 1` 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
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AnAWvwc� I F (4CSL
OFULL
❑ UNEXPIRED
FULL NAME (First, Middle, Last)
PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT'
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r � � V, a "
PERMANENT RESIDENCE ADDRESS (Do not inclutrg a P.O. Box or Rural
PUBLIC MAILING ADDRESS (CampaigF4nailing 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.)
CITY
STATE
ZIP
CITY
STATE
ZIP
�1
-VX
q5-0 I I
Co e
Tx
PUBLIC EMAIL ADDRESS (If available)
OCCUPATION (Do not leave blank)
DATE OF BIRTH
VOTER REGISTRATION VUID
NUMBER (Optional) 2
TELEPHONE CONTACT INFORMATION (Optional)
LENGTH dF CONTINUOUS RESIDENCE
AS OF DATE APPLICATION SWORN
IN STATE
IN TERRITORY FROM WHICH THE
Home:
OFFICE SOUGHT IS ELECTED
Work:
T S year (s)
119 year (s)
Cell:
10
AA—
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.
1 1 C__" -
Before me, the undersigned authority, on this day personally appeared (name) �'���-h 111 Q. 1� �S/L — �^^w' ho being by me
here and now duly sworn, upon oath says: 10
—�
1, (name) "'�>VM_V`V\Q_AC11&*A •o$ —c Iwv, of \J0.1aS County, Texas, being a
candidate for the office of Vv. ICL(_2 swear that I will support and defend the Constitution and laws
of the United States and of the State of Texas. 1 m a citizen o 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." _
P—D h,
____
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SIGNATURE OF CANDIDATE
Sworn to and subscribe before me at this the ay o rr" ASHLEY M. OWENS
.„ Notarl��blic, State of T
CS : Comm. Expires 02-24-2
Notary ID 13012812
Signature of Officer A inistering Oath Title of Aicer Administering th
TO BE COMPLETED B ITY SECRETARY OR SECRETARY OF BOARD:
(See Section 1.007) i 1�3 2Oz'
Date Received Signature of Secret
Voter Registration Status Verified Ed