Connie Baker - Application for a Place on the Ballot - 01-14-2021 2-21
Prescribed by Secretary of State
Section 141.031,Chapters 143 and 144,Texas Election Code
112017
ALL INFORMATION IS RE UIRED TO BE PROVIDED UNLESS INDICATED OPTIONAL
APPLICATION FOR A PLACE ON THE CITY OF DENTON,TEXAS GENERAL ELECT ON BALLOT
TO:City Secretary/Secretary of Board
RECEIVED
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 TER
De n"!-O n 0 i+y Oou n e f D 15t if,), N FULL City Manager's/City
UNEXPIRED Secretary's Office
FULL NAME(First,Middle,Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT
0 0 n n I D. e lee r CIO n n 1 e_ Q -Ke v,
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.)
3� 13 call Meadow �t
CITY STATE ZIP CITY STATE ZIP
LNn4or\ t K -76.,ao�
PUBLIC EMAIL ADDRESS(If available) OCCUPATION(Do not leave blank) DATE OF BIRTH VOTER REGISTRATION VUID
i NUMBER(Optional)Z
ip W 96 314
TELEPHONE CONTACT INFORMATION(Optional) LENGTH OF CONTIN TE APPLICATION SWORN
Home: IN STATE IN TERRITORY FROM WHICH THE
OFFICE SOUGHT IS ELECTED3
Work. �syear(s) year(s)
Cell: q'cf a — month(s) 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.
Before me,the undersigned authority,on this day personally appeared(name) 42�G•SRiiGG� who being by me
here and now duly sworn,upon oath says:
"I, (name) of County, 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 th 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 correct."
X '
SIGNATURE OF ROSA A. RIOS
Sworn to and subscribed before me at nJ•o? this the day o - t _Notary u ic,State of Tex s
Comm,S�ires 05-23-202
Notary ID 8760780
Signature of Officer nl tiring, a 4 Title of Office Administering Oath
TO BE COMPLETE 1 R SECRETARY OF BOARD:
(See Section 1.007 s if
i DateTTTRece'I___v d Signature of Secretary
Voter Registration St F 4