Laserfiche WebLink
2-21 <br /> Prescribed by Secretary of State <br /> Section 141.031,Chapters 143 and 144,Texas Election Code <br /> 1/2017 <br /> ALL INFORMATION IS REQUIRED TO BE PROVIDED UNLESS INDICATED OPTIONAL <br /> APPLICATION FOR A PLACE ON THE CITY OF DENTON,TEXAS GENERAL EL CiltildgiVOT <br /> TO:City Secretary/Secretary of Board <br /> I request that my name be placed on the above-named official ballot as a candidate for the office indicated below. JAN'1 5 2020 <br /> OFFICE SOUGHT(Include any place number or other distinguishing number,if any.) INDICATE T RM <br /> City Manager's/City <br /> /' `L/) <br /> /n ®FULL Secretary's Office <br /> 0.yb G <br /> r ►�fy O F ien-Mn ❑UNEXPI'ED <br /> FULL NAME(First,Middle,Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT1 <br /> Ger Lrd Dap id krudspeA c€/ 1fvdc e -A <br /> PERMANENT RESIDENCE ADDRESS(Do not include a P.O.Box or Rural PUBLIC MAILING ADDRESS(Campaign mailing address,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.) <br /> Gots 5-f-0-e.e- - 0, &6x /04/ 5 <br /> CITY STATE ZIP CITY STATE ZIP <br /> Den+0A T x 7602oS 7 +t fri TX Xz¢Z. <br /> PUBLIC EMAIL ADDRESS(If available) OCCUPATION(Do not leave blank) DATE OF BIRTH VOTER REGISTRATION VUID <br /> NUMBER(Optional)2 <br /> germ For n <br /> t9_e . ►Mos! .co.. GCh try( mdnili gr 1/ /28 //572 <br /> "TELEPHONE CONTACT INFORMATION(Optional) LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN <br /> Home: /VI/}- IN STATE IN TERRITORY FROM WHICH THE <br /> 3� ,_ C3 7 OFFICE SOUGHT IS ELECTED3 <br /> Work: y LI 'oZ / <br /> Li 7 year(s) 4 7 year(s) <br /> Cell: 21 y _ 51/3 - 90{p .tt month(s) ..Z 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) (; 9� <br /> i /�p/r_R ,who being by me <br /> here and now duly sworn,upon oath says: // <br /> "I, (name) Com .,S4' of <br /> ...?--t-,� County, Texas, being a <br /> candidate for the office of /,Q�e /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 application are in all things true and correct." <br /> SIGNATURE OF CANDID r+"Y;w, ROSH A RIOS <br /> Sworn to and subscribed before me at ("414 / x'4,4,this the /5 day of2,0,,,,s� , _ i A,t :°f `�``-i..1 Notary PublC <br /> ytik,, , f'3 / 1-\,..,,,i,,‘%�:.` eA6TAot OF TEXAS <br /> Atwa'v.. .F eT •• P ID#8x6078-C <br /> diQ .� !+�``°�s i� or My Comm.Exn.Mav'3,2020 <br /> & :i Signature of Officer Admit I,tyerg OO ' ' Title of Officer Administering Oath <br /> TO BE COMPLETED BY CITASEC 40. <br /> F B ARD: <br /> (See Section 1.007) 4'': � € /24,9 <br /> . ,; /A ,D f eived Signature of Secretary <br /> Voter Registration Status VeR[fCe ` M,..�' ` ,s <br /> ^C: rI y a <br /> 'f! Lift/txb <br />