HomeMy WebLinkAboutVaughn, Blake Candidacy Application 2023 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 OPTIONAL1 Failure to provide required information may result in rejection of application.
APPLICATION FOR A PLACE ON THE /l A 6, 2ri Z3 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.) INDIC E TERM n
6 l Coan.' ( (�lG�,GL $ I [FULL I I UNEXPIRED
FULL NAME(First,Middle,Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT*
/3/6k- J 144 A.jft kg. '5k e Vc v ki."
PERMANENT RESIDENCE ADDRESS(Do no include a P.O.Box or Rural Route.If PUBLIC MAILING ADDRES (Optional)(Address for which you receive
you do not have a residence address,describe location of residence.) campaign related correspondence,if available.)
g'I 0°[ 1ce.LrllKr G-
CITY STATE ZIP CITY . STATE ZIP
N(b1i Tx 741 alZ
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.) NUMBER2(Optional)
/3l oik e.t'I NIZN a-,,n.a,? .GoiN 1-14:Msf & cr
TELEPHONE CONTACT INFORMATION(Optional)
Home: Office: Cell: 617'Za3. 4 l$"Z
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
❑ I have been finally convicted of a felony,but I have been WHICH THE OFFICE SOUGHT IS ELECTED
pardoned or otherwise released from the resulting ✓�? year(s) Z 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)
*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 1
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) J3)�lrti VG,,..c J-i... ,who
being by me here and now duly sworn,�upon oath says:
"I,(name of candidate) 13I'k. V A.__ ,of '-o%/w--'' County,Texas,
being a candidate for the office of (�S Gawa��.3 Pike( , swear that I will support and defend the Constitution and
laws of the United States and of the State o 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 1
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 stateme nclude_d in my application are in all things true and correct."
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SIGNAT CANDIDATE
Sworn to and subscribed before me this the /S'4-day of 3244.004- , ZO 6.ri3 ,by 8 .Le. �,,/acc5hn
(day) (month) (year) (name of candidate)
Signature of Officer Authorized to Administer Oath4 Prir ed, of Ottl •mini ter Oath
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Title of Officer Authorized to Administer Oath •ov fit' Expires September 12,2025
TO BE COMP TED BY FILING OFFICER: THIS APPLICATION IS ACCOMPANIED BY ,r1 1 t juuKcu mum 1-tt Or Applicable,PAID BY:
❑CASH II CHECK ❑MO ORDER ❑CASHIERS CHECK OR ❑PETIT ON IN LIEU OF A FILING F,EE.
This document and$ 1S°'00 filing fee or a nominating petition of ages received. U Vot Regi tration Status Verified
10 / .44,`2
� ' / '8 / Po (See Section 1.007) `t —®
Date Received Date Accepted Signature of,Filing Officer or Designee