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HomeMy WebLinkAboutOrr, Mason Candidacy Application 2024 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 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 / vr-74) Ak.4 OAd ,/f://.r 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. OFFICEA4,44 SOUGHT(Include a y'pllace number or other distinguishing/number,if ny.) IND�IC TE TERM //4 �,•�+1 y,��f GA Cov-ed /QGei I "I FULL UNEXPIRED FULL NAME(First,Middle,Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT* /l san ,Uo,. /Os' 0r, ara-v pr- PERMANENT RESIDENCE ADlss(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.) d6' Z CA."Ff.() % Cl. CITY STATE ZIP CITY STATE ZIP Air r..44 /?4 Add/%,I rX 76Id 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) Vice. e nbft ii'7 ) d i24€4' TELEPHONE CONTACT INFORMATION(Optional) Home: Office: Cell: © i7 "69?- Yt/-S FELONY CONVICTION STATUS(You MUST check one) LENGTH OF CONTINUOUS RESIDENCE AS OF DATE THIS APPLICATION WAS SWORN LS 11'1 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 ^37 year(s) year(s) disabilities of that felony conviction and I have provided proof of this fact with the submission of this application.3 7 _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) ,/1/1c.,r•e, r ,who being by me here and now duly sworn,upon oath says: "I,(name of candidate) ,4/1 a,roi+ O(r' ,of County,Texas, being a candidate for the office of /✓e '/ Co /see- 4 , 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 applica ' n are in all things true and correct." X SIGNATURE OF CANDIDATE Sworn to and subscribed before me this the '� 'day of J tA .6 1 by • (day) (month) (year) (name of candidate) Signature of Officer Authorized to Administer Oath4 0""",, ALICIAPhi(dA '16 ly'r Officer Authorized to Administer Oath ly 6 *(*.-a=Notary Public,State of Texas Comm,Expires 0�2��-� r fficial Seal ' ~f?'� Title of Officer Authorize o Administer Oath ,e Notary ID 86000F2 TO BE CO LETED BY FILING OFFICER: THIS APPLICATI„ -= r s; -: FILING FEE(If Applicable)PAID BY: CASH CHECK ❑MONEY ORDER ❑CASHIERS CHECK OR ❑PETITION IN LIEU OF A FILING FEE 00 This document and$ 0 filing fee or a nominating petition of pages r ceived. U Voter Registration Status Verified / `, / } ° / / (See Section 1.007) Date Received Date Accepted Signature of Filing Officer or Designee