Carroll, Don-AP 2021-02-082-22
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 City of Coppell SPECIAL 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.)
Coppell City Council Place 3
FULL NAME (First, Middle, Last)
PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT'
Don Roger Carroll, Jr
Don Carroll
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.)
CITY
STATE
ZIP
CITY
STATE
ZIP
Coppell
TX
75019
Coppell
TX
75019
PUBLIC EMAIL ADDRESS (If available)
OCCUPATION (Do not leave blank)
DATE OF BIRTH
VOTER REGISTRATION VUID
NUMBER (Optional)2
campaign@farmersfight.net
banker
1078211309
TELEPHONE CONTACT INFORMATION (Optional)
LENGTH OF CONTINUOUS RESIDENCE
AS OF DATE APPLICATION SWORN
IN STATE
IN TERRITORY FROM WHICH THE
Home:(
OFFICE SOUGHT IS ELECTED
Work:
50 year (s)
13 year (s)
Cell:
9 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) Don R Carroll, Jr who being by me
here and now duly sworn, upon oath says:
1, (name) Don R Carroll, Jr of Dallas County, Texas, being a
candidate for the office of Coppell City Council Place , -1 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."
X /
,
SIGNATURE OF
Sworn to d subscribed ore me at this theay of ASHLEY M. OWENS
Notary Pu96ALState of Texas
Comm. Expires 02-24-2023
Notary ID 130128128
Signature of Officer A ministering Oath Title of Off' r Administering Oath
TO BE COMPLETED bf CITY SECRETARY OR SECRETAJY OF OARD:
(See Section 1.007) Zq 1 'zol Ck A A
Date heceived Signature of Secret ry
Voter Registration Status Verified