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Application - Hill, Mark 2-26 Prescribed by Secretary of State Section 141.031,Chapters 143 and 144,Texas Election Code 09/2021 APPLICATION FOR A PLACE ON THE BALLOT FOR A GENERAL ELECTION FOR A CITY, SCHOOL DISTRICT OR OTHER POLITICAL SUBDIVISION ALL INFORMATION IS REQUIRED TO BE PROVIDED UNLESS INDICATED AS OPTIONAL1Failure to provide required information may result in rejection of application. APPLICATION FOR A PLACE ON THE Coppell 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. OFFICE SOUGHT(Include any place number or other distinguishing number,if any.) INDICATE TERM City Council, Place 7 FULL UNEXPIRED FULL NAME(First, Middle, Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT* Mark Straughn Hill Mark Hill 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 correspondence,if available.) 1029 Basilwood Drive CITY STATE ZIP CITY STATE ZIP Coppell TX 75019 PUBLIC EMAIL ADDRESS(Optional)(Address for OCCUPATION(Do not leave blank) DATE OF BIRTH VOTER REGISTRATION VUID which you receive campaign related emails,if available.) NUMBER,(Optional) MarkHillforCityCouncil@gmail.c Architect TELEPHONE CONTACT INFORMATION(Optional) Home:(972) 679-9517 Office: (214) 520-8878 Cell: (972) 679-9517 FELONY CONVICTION STATUS(You MUST check one) LENGTH OF CONTINUOUS RESIDENCE AS OF DATE THIS APPLICATION WAS SWORN E I have not been finally convicted of a felony. IN THE STATE OF TEXAS IN TERRITORY/DISTRICT/PRECINCT FROM I have been finally convicted of a felony,but I have been WHICH THE OFFICE SOUGHT IS ELECTED 26 year(s) 24 year(s) pardoned or otherwise released from the resulting disabilities of that felony conviction and I have provided proof of this fact with the submission of this application.3 month(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 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) Mark Hill ,who being by me here and now duly sworn,upon oath says: "I,(name of candidate) Mark Hill of Dallas County,Texas, being a candidate for the office of City Council, Place 7 , 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 t - application regarding my possible felony conviction status constitutes a Class B misdemeanor. I further swear that the foregoing stat en s i^c - my application are in all things true and correct." SIGNATURE OF CANDIDATE,r /� Sworn to and subscribed before me this the I l U ay of vG , � Mary�3 , by k k\i. it /, (day) (month) (year (name of candidate) S�`1�```,v.y pl//y ASHLEY M. 0 I alt)uthorizedo ,...68 iSignature of Officer Auth ized to Administer Oath° _° fin:Notary Publjrin ' ero xraf icer Administer Oath ��� "4: Comm.Expires e0 -Ci 2� g73 /,,,,,,,�. Notary ID 130128128 II Title of Officer A rized to Administer Oath TO BE COMPLETED BY FILING OFFICER: THIS APPLICATION IS ACCOMPANIED BY THE REQUIRED FILING FEE(If Applicable)PAID BY: ❑CASH ❑CHECK ❑MONEY ORDER n CASHIERS CHECK OR PETITION IN LIEU OF A FILING FEE This document and$ filing fee or a nominating petition of pages reclive%. er Registration Status Verified 0 I / I b / ton 0 /1. /2OZ- (See Section 1.007) t,1 r Date Received Date Accepted Signature of Filin:' icer or Designee