Shoemaker, Meghan-AP 2021-02-112-22
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 Coppell city council 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'
Meghan Kathleen Shoemaker
Meghan Shoemaker
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
474 Sandy Knoll Dr.
at which you receive personal mail and location of residence.)
474 Sandy Knoll Dr.
CITY
STATE
ZIPCITY
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
CPS Caseworker
TELEPHONE CONTACT INFORMATION (Optional) LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN
Home: IN STATE IN TERRITORY FROM WHICH THE
OFFICE SOUGHT IS ELECTED
Work:
' year (s) year (s)
Cell: 720-240-6194 s
month(s) 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.
Before me, the undersigned authority, on this day personally appeared (name) Meehan Shoemaker who being by me
here and now duly sworn, upon oath says:
"I, (name) Meghan Shoemaker of Dallas County, Texas, being a
candidate for the office of Coppell City council Place 3 . 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
SIGNATUREOF CA , �,, ASHI EY M MEN
Sworn to and subscribe efore me at, this the / day of ; o`P'"" °��' Notary Public, State ofti
Cortxplres 02-24-2
C` /� /� ''.;°.`� Notary ID 13012812
o
Signature of Officerministering Oath" Title of Officer Adm' stering Oath
TO BE COMPLETED bkiTy SECRETARY OR SECRQARY F BOARD:
(See Section 1.007) 11 I
Date Received Signature of Secreta
Voter Registration Status Verified
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