Anderson Application for Place on Ballot - 03/03/2020 2-22
Prescribed by Secretary of State
Section 141.031,Chapters 143 and 144,Texas Election Code
1/2017
ALL INFORMATION IS RE UIRED TO BE PROVIDED UNLESS INDICATED OPTIONAL
APPLICATION FOR A PLACE ON THE City of Denton, Texas SPECIAL RECE(VP6O
TO:City Secretary/Secretary of Board
1 request that my name be placed on the above-named official ballot as a candidate for the office indicated below. I.''
OFFICE SOUGHT(Include any place number or other distinguishing number,if any.)
City Manager's 1 City
J O+ r Secretary's Office
FULL NAME(First,Middle, siq PRINT NAME AS YOU WANT IT TO APPEAR
f\A�� V,0 Ao1,( k A 6-w,
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.)
qUA
CITY STATE ZIP CITY STATE ZIP
0ua v 1 \ ` "-?(4WI)
PUBLIC EMAIL ADDRESS(If available) OCCUPATION(Do not leave blank) DATE OF BIRTH VOTER REGISTRATION VUID
NUMBER(Optional)'
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: 51 year(s) year(s)
Cell:
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 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. S
Before me,the undersigned authority,on this day personally appeared(name) r_ n.,_L ," who being by me
here and now duly sworn,upon oath says:
"I, (name) of b _ County, Texas, being a
candidate for the office of Gwff Eon A.nCt` T3kS 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 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 and co rect."
X 0�ryL__
SIGNATURE ND
Sworn to and subscribed before me at this the day of ".� .°e
'• otary Public
•' " TIME OF TEXAS
ID#876078-0
0 911 111P., My Comm.Exp.May 23, i020,
Signature of Officer Admin,(sh Title of Officer dministering Oath
TO BE COMPLETED BY eS CST Y 0�2•�I?�j RY OF BOARD:
V : !�
(See Section 1.007)
%D SR ceived Signature of Secretary
Voter Registration St s Vorm
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