Application - Nevels, Kevin 2-49
Prescribed by Secretary of State
Section 141.031,Chapters 143 and 144,Texas Election Code
09/2023
APPLICATION FOR A PLACE ON THE BALLOT FOR A GENERAL ELECTION
FOR A CITY, SCHOOL DISTRICT OR OTHER POLITICAL SUBDIVISION
AU.INFORMATION IS REQUIRED TO BE PROVIDED UNLESS INDIf1'TED AS OPTIONAL'Failure to provide required information may result in rejection of application.
APPLICATION FOR A PLACE ON THE Lcpn e U( C3< ('y CCUYtc\ I GENERAL ELECTION BALLOT
TO:City Secretary/Secretary of Board (name of election)
I request that my name be placed on the above-named official ballot as a candidate for the office indicated below.
FFUO)`FI�CE SOUGHT(Inc\�e any placenumber or���di��ishi�number,if any.)Pe INDICATE TERM FULL UNEXPIRED
ULL VAME(`First,MMiddlel Last)t) ,` l PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT'
Ke\) Th cva el AitUek3 -�e..v, A Aieveils
PERMANENT RESIDENCE ADDRESS(Do not include a P.O.Box or Rural Route.if PUBLIC MAILING ADDRESS(Optional)(Address for which you receive
you do not have a residence address,describe location of residence.) campaign related corre_spondennce,if available.)
Iba rl K 3 h`1 y`e- LV�',/TATE ZIP CITY FIl b(1i l-j`''1Cy c_.,pp uSTATE ZIP
CITY �5
Cspe\ -t-y -6N c(
rx 7s0( ci
PUBLIC EMAIL ADDRESS(Optional)(Address for OCCUPATION(Do not leave blank) DATE OF BIRTH VOTER REGISTRATION VUID
which yo receive campaign related emails,if available.) NUMBER2(Optional)
in"P� kevir�.eti�els , Cow Stnal( isowe3s C)cki �r
TELEPHONE CONTACT INFORMATION(Optional) 'II,^C, 7 ¢ //�� 'r
Home: Office: Cell:4b l r33- 0 3` ,S
FELONY CONVICTION STATUS(You MUST check one) LENGTH OF CONTINUOUS RESIDENCE AS OF DATE THIS APPLICATION WAS SWORN
I have not been finally convicted of a felony. IN THE STATE OF TEXAS IN TERRITORY/DISTRICT/PRECINCT FROM
fill I have been finally convicted of a felony,but I have been 7 WHICH THE OFFICE SOUGHT IS ELECTED
pardoned or otherwise released from the resulting / years) year(s)
disabilities of that felony conviction and I have provided
proof of this fact with the submission of this application.3 ` month(s) month(s)
tlf 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 or contain a title, 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. Please review sections 52.031,52.032 and 52.033 of the Texas
Election Code regarding the rules for how names may be listed on the official ballot.
Before me,the undersigned authority,on this day personally appeared(name of candidate) K2 V I Y-t k1 tv PIS ,who
being by me here and now duly sworn,upon oath says:
"I,(name of candidate) X e V I VI /V-w Ls ,of b a(1 i.) County,Texas,
being a candidate for the office of Copp-([i Cc I5/ inUht/l Plc € / , 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 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 am aware that I must disclose
any prior felony conviction,and if so convicted,must provide proof that I have been pardoned or otherwise released from the resulting disabilities of
any such final felony conviction. I am aware that knowingly providing false information on the application regarding my possible felony conviction
status constitutes a Class B misdemeanor. I further swear that the foregoing statements included in my application are in al, ..tt ngs true and correct."
X 7<_:— 7.'--2----- ,
/7 t SIGNATURE OF CANDIDATE
Sworn to and subscribed before me this the 9 1 day of JGU'ItI 0. , 02 '-I ,by e� t
(day) (•1•. . . (name of candidate)
�tPNY P'''' ill
W 1
_ir• �iNat•' �"��� ' .1
Signature of OAcP
zed to Administer Oath4115
'iPc CofiliggelOW539-0iii4,27Authorized to Administer Oath
'.vit�n°i,.- Notary ID 130128128
Title of Offic uthorized to Admi ter Oath
TO BE COMPLETED BY FILING OFFICER: THIS APPLICATION IS ACCOMPANIED BY THE REQUIRED FILING FEE(If Applicable)PAID BY:
CASH ❑CHECK CI MONEY ORDER ❑CASHIERS CHECK OR ❑PETITION IN LIEU OF A FILING FE
This document and$ filing fee or a nominating petition of pages rece'ved. Voter Registration Status Verified
`b l / 11 / 2D ZJ' O l / Vl / 202-4- (See Section 1.007)
Date Received Date Accepted Signature of Fili g Officer or Designee
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