Fletcher, Eliot-AP 2021-02-02 (PL 4)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 OPTIONAI
APPLICATION FOR A PLACE ON THE ci 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
City Council Place 4
E FULL
❑UNEXPIRED
FULL NAME (First, Middle, Last)
PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT'
Eliot Sananikone Fletcher
Eliot S. Fletcher
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.)
517 Harris St
517 Harris St
CITY
STATE
ZIP
CITY
STATE
ZIP
Coppell
Texas
75019
Coppell
Texas
75019
PUBLIC EMAIL ADDRESS (If available)
OCCUPATION (Do not leave blank)
DATE OF BIRTH
VOTER REGISTRATION VUID
NUMBER (Optional) 2
fsanan@gmail.com
Senior Scientist/ Army Officer
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:
8 year (s)
2 year (s)
Cell: 617-869-6816
_2 _ month(s)
9 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) Eliot S. Fletcher who being by me
here and now duly sworn, upon oath says:
"I, (name) Eliot S. Fletcher of Dallas County, Texas, being a
candidate for the office of Coppell City Council Position 4 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."
IGNATURE OF pnmn. inn
Sworn to a d subscribed fore meat this the day offP A N, a��.,, ASHLEY M. WENS
Notary PsMi State of Texa
Comm.
Expires 02-24-2023
Of Notary ID 130128128
Signature of Officer AA inistering Oath Title of O er Administering 014h
TO BE COMPLETED BtJTY SECRETARY OR SECRETARY OF BOARD:
(See Section 1.007) 4.I 6) n,2 1 OL ,J_�
Date Received Signature of Secret
Voter Registration Status Verified