Daniel Clanton - Application for a Place on the Ballot - 02-11-2021 2-21
RECEIVED Prescribed by Secretary of State
Section 141.031,Chapters 143 and I",Texas Election Code
IM17
LL I IS E IRED TO BE PROVIDED UNLESS INDICATED OPTION
APB PLICAT FOR A PLACE ON THE GENERAL ELECTION BALLOT
'ai rs 1 e etary of Board
Secre ary
I re uest 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 TERM
L=1 FULL
❑UNEXPIRED
FULL NAPAElFirst,Middle,Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT'
RMAN'ENT 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 .2-
at which you receive personal mail and location of residence.)
CITY STATE ZIP CITY STATE ZIP
Dl (?, 7x W.7&f1 '�J eeet -/ )( wl l;le f
PUBLIC EMAIL ADDRESS(If available) OCCUPATION(Do not leave blank) DATE OF BIRTH VOTER REGISTRATION VUID
NUMBER(Optional)2
TELEPHONE CONTACT INFOR ATION(Optional) OF LENGTH OF CONTINUMS RIESIVENLIE AgMATE APPLICATION SWORN
Home: IN STATE IN TERRITORY FROM WHICH THE
OFFICE SOUGHT IS ELECTED;
Work: 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.I)a
/Before me,the undersigned authority,on this day personally appeared(name) n' �/ ( �� � who being by me
here and now duly sworn,upon oath says: / ��
"I, (named a �, � �i � `w of tJlmoen 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 the a 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 n all things true and correct."
1
X -- _ --
4 SIGNATURE OF CANDIDATE
Sworn to and subscribed before me at this the day of
fiF -
;* Z NA R PARKER
.� Notary Public
* STATE OF TEXAS
5tgna ure ministering Oath" Title of Ic dmini a ing Oath ID#12 LSgi 7
TO B SECRETARY OR SECRETARY OF BOARD:
(See
Date Received Signature of Secretary
p G
Voter ti n S ~ erified