Baria Application - 01/15/20202-21
Prescribed by Secretary of State
Section 141.031, Chapters 143 and 144, Texas Election Code
1/2017
ALL INFORMATION IS REQUIRED TO BE PROVIDED UNLESS INDICATED OPTIONAL
APPLICATION FOR A PLACE ON THE CITY OF DENTON, TEXAS GENERAL ELECTIO
TO: City Secretary/Secretary of Board
N 5 7020
1 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 TERF4 Citymanager's / City
12rSecretary's Office
FULL
Derlir) CI �
v y Coanc, Place 5
❑UNEXPIRED
FULL NAME (First, Middle, Last)
PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT'
Richartl Aylen itCL07,r
RICik Qaria
PERMANENT RESIDENCE ADDRESS (Do not include a P.O. Box or Rural
PUBLIC MAILING ADDRESS (Campaign mailing address, if available.)
Route. If you do not have a residence address, describe the address
at which you receive personal mail and location of residence.)
P, 0. 52 055
51 12 Warc.� s Pc#
CITY
STATE
ZIP
CITY
STATE
ZIP
Den �c n
Tx,
7620 S
OP,0-foil
Tx
1-ito2n6
PUBLIC EMAIL ADDRESS (If available)
OCCUPATION (Do not leave blan7DATE,,OF
BIRTH
VOTER REGISTRATION VUID
NUMBER (Optional)Z
Layvk Piarnr►er
-th
10co-oy �
TELEPHONE CONTACT INFORMATION (Optional)
LENGTH OF CONTINUOUS RESIDENCE
AS OF DATE APPLICATION SWORN
Home:
IN STATE
IN TERRITORY FROM WHICH THE
OFFICE SOUGHT IS ELECTED3
Work:
4c) year (s)
3 a year (s)
Cell: f�i+O
_/ 3 q I 2_4
'2—month(s)
J 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 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.
Before me, the undersigned authority, on this day personally appeared (name) ,f��, ,g �1� who being by me
here and now duly sworn, upon oath says:
"I, (name) ofCounty, Texas, being a
candidate for the office of swear that I will support and defend the Constitution and laws
of the United States and of the tate 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 finally convicted of a felony for which I have not been pardoned or had my full rights of citizenship restored by other
official action. 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 further swear that the foregoing statements included in my application are in all things true a d rorrect."
X
IGN TURE OF tA
Sworn to and subscribed before me at e411 1Z this the _lc_�clay of Y Py ROSA A RIAS
ry Public
TEXA
STATE S
& g yr�OF
�N v / ,. , Ny Comm. Exp. Mav 23.20 4 i
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Signature of Officer Administering O `;; r,;:.. «.'.,� Title of Officer Administering Oath
TO BE COMPLETED BY CITY SECRET`t(,- ,. CRETA Y OE D:
i
Section 1.007)
(See a p"
--f t eiv ,( Signature of Secretary
`
== f'..e
Voter Registration Status Verified" .a� �.0