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Application - Premkumar, Ramesh 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 OPTIONAL'Failure to provide required information may result in rejection of application. APPLICATION FOR A PLACE ON THE Coppell City Council 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 1 VFULL UNEXPIRED FULL NAME(First,Middle,Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT* Ramesh Premkumar Ramesh Premkumar 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.) 106 London Way CITY STATE ZIP CITY STATE ZIP Coppell TX 75019 PUBLIC EMAIL ADDRESS(Optional)(Address for 1 OCCUPATION(Do not leave blank) DATE OF BIRTH VOTER REGISTRATION VUID which you receive campaign related emails,if available.) I $r\Gk.'). 1 NUMBER2(Optional) rk4f.r p ll©)mail rnrg 1510 l-/ 4154096 TELEPHONE CONTACT INFORMATION(Optional) Home: Office: Cell: (972)765-1606 FELONY CONVICTION STATUS(You MUST check one) LENGTH OF CONTINUOUS RESIDENCE AS OF DATE THIS APPLICATION WAS SWORN Q 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 15 year(s) 14 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 1 month(s) 8 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) Ramesh Premkumar ,who being by me here and now duly sworn,upon oath says: "I,(name of candidate) Ramesh Premkumar of Dallas County,Texas, being a candidate for the office of City Council , 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 a_pplication regarding my possible felony conviction status constitutes a Class B misdemeanor. I further swear that the foregoing statements i ed in my ap ication are in all things true and correct." X 7-3 /- SIGNATUR CANDIDATE Sworn to and subscribed ore me this the 18 day of January 2023 by Ramesh Premkumar . (day) (month) (year) (name /o�f/candidate) �*a�?u° Signa re of Officer Aut rized to Administer Oath° 3z {tlsfn[f rR��NLf$iE ''4 ?S��crfto Administer Oath T4 +�i Comm. Expires 02-24-2023 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 ❑CASHIERS CHECK OR ❑PETITION IN LIEU OF A FILING FEE This document an^^dam� n $ filing fee or a nominating petition of pages r cei d.r Vote tration Status Verified 0\ / 1�D / GCJv3 O\ / et. / 123 (See Section 1.007) - Date Received Date Accepted Signature of Filing Offic r Designee