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2-21 <br /> Prescribed by Secretary of State <br /> Section 141.031,Chapters 143 and 144,Texas Election Code <br /> 10.91\ <br /> ALL INFORMATION IS REQUIRED TO BE PROVIDED UNLESS INDICATED OPTIONAL <br /> APPLICATION FOR A PLACE ON THE CITY OF DENTON,TEXAS GENERAL ELE IfiRWISQ <br /> TO:CitySecretary/Secretary of Board <br /> JAN 1 5 2Q2g <br /> I request that my name be placed on the above-named official ballot as a candidate for the office indicated below. <br /> OFFICE SOUGHT(Include any place number or other distinguishing number,if any.) INDICATE TE kitty Managers I City <br /> ` Ma Secretary's Office <br /> t\ ✓ery- b,/�\ yo 2" ❑UNEXPIRED <br /> FULL NAME(First,Middl ,Last PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT' <br /> '4(a a eS e_ GI )44) 616 k <br /> PERMANE RESIDENCE ADDRESS(Do not include a P.O.Box ord PUBLIC MAILING ADDRESS Campaign mai ddress,if available.) <br /> Route. If you do not have a residence address, describe the address <br /> at which you receive personal mail and location of residence.) - O- . g(D 142M F_Ny0 <br /> I o Z EC O KLrl gow Si- 1 <br /> CITY STATE ZIP CITY STATE ZIP <br /> 1Dtgl - <br /> y\ y t,,,20 . ,,,,„6.\ 7x i[0iO9 <br /> PUBLIC EMAIL ADDRESS(If available) OCCUPATION(Do not leave blank) DATE OF BIRTH VOTER REGISTRATION VUID <br /> 1)- CAT`/ ( ' Da/14741 <br /> O NUMBER(Optional)2 <br /> br% g)seedeA cu Con, ! !� /a5 / _.� <br /> TELEPHONE CONTACT INFORMATION(Optional) LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN <br /> Home: `i%0 _ 3310_ "- ? ? C�L IN STATE IN TERRITORY FROM WHICH THE <br /> 4`(.1 <br /> 7 OFFICE SOUGHT IS ELECTED3 <br /> Work: L� <br /> year(s) o?S-- year(s) <br /> Cell: <br /> / 0 month(s) month(s) <br /> 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 <br /> that my nickname does not constitute a slogan nor does it indicate a political, economic, social, or religious view or affiliation. I have been <br /> commonly known by this nickname for at least three years prior to this election. //�� <br /> Before me,the undersigned authority,on this day personally appeared(name) A ',' �/w 7( ,who being by me <br /> here and now duly sworn,upon oath says: <br /> "I, (name) /e�1�,,,, > , of 2.00,04x.) County, Texas, being a <br /> candidate for the office of 7,--1-7/0//g/L, /giOPl 7 ,swear that I will support and defend the Constitution and laws <br /> 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 <br /> this state. I have not been finally convicted of a felony for which I have not been pardoned or had my full rights of citizenship restored by other <br /> official action. I have not been determined by a final judgment of a court exercising probate jurisdiction to be totally mentally incapacitated or <br /> partially mentally incapacitated without the right to vote.I am aware of the nepotism law,Chapter 573,Government Code. <br /> I further swear that the foregoing statements included in my applicationare in al hings true and corr <br /> X � - <br /> S = ATU•E OF CA �•_____ <br /> /- <br /> Sworn to and subscribed before me at 47-1/4/1//:PS',this the/1'41 day of _ >.: _ .il v ROSA A RIO <br /> I ry Public <br /> ' g+�,N ?�� 9 n f, ‘4,7'1:,:i., ,,,...,';C5 OF TEXAS <br /> / ID#878078-0 <br /> �tII 40 A-V. 'r\....... ?< 7/ �Lrfi/L' M. M Comm.Exo,Ma 23,2020 <br /> Signature of Officer Administering• °`f. ``'s�„�.• Title of Offic Administering Oath <br /> TO BE COMPLETED BY CITY SECRE } MSEC' .' •F y•c:!: <br /> (See Section 1.007) <` <� ,e'_ �n d ��?�. <br /> of ^, P.-• a _1 ,;;; Signature of Secretary <br /> Voter Registration Status Verified <br /> yr <br /> -W4. teN- <br />