Anderson, Robert-AP 2021-02-11ALL INFORMATION IS
TO BE PROVIDED UNLESS INDICATED OPTIONAL
APPLICATION FOR A PLACE ON THE
TO: City Secretary/Secretary of Board
2-2:
Prescribed by Secretary of Stat(
Section 141.031, Chapters 143 and 144, Texas Election Cod(
11201;
GENERAL ELECTION BALLOT
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.) IND TE TERM
U t
12f FULL
O UNEXPIRED
FULL NAME (First, Middle, Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE
ob e c St J ov r.. Q S r1 �., Q s
PERMANENT RESIDENCE ADDRESS (Do not include a P.O. Box or Rural
Route. If you do not have a residence address, describe the address
at which you receive personal mail and location of residence.)
CITY
PUBLIC EMAIL ADDRESS (If available)
STATE ZIP
7x I 15o\9
o1:3 -a. n Q u o r�_
rUBLIL MAILING ADDRESS (Campaign mailing address, if available.)
CITYTE STA
( -0 � R ¢L �' `C X ZIP
OCCUPATION (Do not leave blank) DATE OF BIRTH
coke�Jankt5o..FP
cl.4.orl.Ca
TELEPHONE CONTACT INFORMATION (Optional)
Home: q1 - 39 3 - 09 O (o
Work:
Cell: �� C� :t - 7 -V0 \ 9 148
VOTER REGISTRATION VOID
NUMBER (Optional) 2
/«(.'
LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN
IN STATE IN TERRITORY FROM WHICH THE
OFFICE SOUGHT IS ELECTED
_Crn, year (s) G year (s)
rnvninisl _Li 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: 1 further swear
that my nickname does not constitute a slogan nor does it indicate a political, economic, social, or religious view or affiliation. 1 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) c� �. �. n�e 5 C-xN I who being by me
here and now duly sworn, upon oath says:
"I, (name) :5M of ���\ County, Texas, being a
candidate for the office of swear that I will support and defend the Constitution and laws
of the United States and of the State of Tex s. 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. l am aware of the nepotism law, Chapter 573, Government Code.
I further swear that the foregoing statements included in my application arein l I StrU4, n orrect."
Sworn to and subscribed before me at
this the VV dao of
Signature of Officer Administering Oath" Title of Officer Admiriistering Oath
L
BE COMPLETED BY CITY SECRETARY OR SECRE AR OF BOARD:
Section 1.007) aj1l 120alDate Received Signature of Secr ryer Registration Status Verified
Ic.blotW ID g 128654071
Expires JuneW, ,023