HomeMy WebLinkAboutArwine, Jeffrey 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 OPTIONAL1 Failure to provid required information may result in rejection of application.
APPLICATION FOR A PLACE ON THE 0 �-1 AIZ lc_MLP 4t LL,S 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 ERM
IC
l �f C e V I i C i L PL.-A C I FULL UNEXPIRED
FULL NAME(First,Middle,Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT*
1r20'c 44iPJ /ale i) Ace jv) 61i
PERMANENT RESIDENCE ADDRESS(Do not include a P.O.Box or Rural Route.If PUBLIC MAILING ADDRESS(Optional)(Address for which you receive
you dgrgq,have a residen�ddres �r( �f reside erLc )_ campaign related correspondence,if available.)
CITY frt/SY 3 Z STATEAV1 /,{.•`Z,I/P,'•' CITY STATE ZIP
4 �1Ci(t O l'il ttS 75( 7b
PUBLIC EMAIL ADDRESS(Optional)(Address for OCCUPATION(Do not leave blank) DATE OF BIRTH VOTER REGISTRATION VUID
which you receivecampa' n related email if av ilable.) NUMBER2 ioptio al
'gygr•gr� j n r e campaign I►
l4 b4,1. �e) 6�� Pi- 16 ) l els 141)5-3
TELEPHONE CONTACT INFORMATION(Optional) �c
Home: Office: Cell: 613Z-2O9- f -5 J
FELON!„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 1 IN TERRITORY/DISTRICT/PRECINCT FROM
ElI have been finally convicted of a felony,but I have been / �J WHICH THE OFFICf�S9UGHT IS ELECTED
pardoned or otherwise released from the resulting Years) G�p year(s)
disabilities of that felony conviction and I have provided month(s) ...08-"*.month(s)
proof of this fact with the submission of this application.3
*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 candidateaeg. AIII W/` v,�ho
being by me here and now dilly sworn,ugorloath says ^� / I
"I,(name of candidate) ./,U / Wry'Air ,of -1A (Q A 1 County,Texas,
being a candidate for the office of AS/t)) ay./ 00v41C7(i �wear 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 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 informa ' n on the applicatio regarding my possible felony conviction
status constitutes a Class B misdemeanor. I further swear that the foregoing state nts nts included in my a plicatio- /
nare in al in/gssp
true
cl correct."
er A` r' ✓l F� t'V l ni
n� SIGNATURE OF CANDIDATE
Sworn to and subscribed before me this the_ day of Feb Uarq , c:�(. W ,by �e ff jreq k c uir O i1/jnt
(day) (month)J (year) name of candidate)
hia,q/(41,0triv �I.c yict ri(Jl
Signet re of Officer Authorized to Administer Oath4 Print.. Name of Officer Autbp z A NS
Admir$ter Oath
MARIA WLLI
kotrufq I :�e
Nit t tdrr��h`�iiission Expires
ID#134664040
II ���V or
Title of Officer Author' to Administer Oath '''°' November 30,2027 )
TOE COMPLETED BY FILING OFFICER: THIS APPLICATION IS ACCOMPANIED BY )PAID BY:
u CASH ❑CHECK ❑MONEY ORDER ❑CASHIERS CHECK OR ❑PETITION IN LIEU OF A FILING
document and$ /SQ•OOfiling fee or a nominating petition of /v/Ik pages r Tr-
Thisoter Registration Status Verified
Oa /Q /na 4 / a / a 6a, (See Section 1.007 ece401. atcvn�,
Date Received Date Accepted Sign ure of Filing Of er or Designee