Matt Irvine - Application for Place on the Ballot - 02-12-2021 2-21
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 (jti -,e)L Dpn_�nr\ , 'rQ__x a<_ GENERALEE
TO:City Secretary/Secretary of Board
ED
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.) IN CAFU s/CityCf C�V �'lCi IJ S t1`i�T UNOfficeFULL NAME(First,Middle,Last) PRINT NAME AS YOU WANT IT TO APPEA
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.) 52 f K',
�Pe,/I diver- 00
I
CITY STATE ZIP CITY II STATE ZIP
e u 76 2Og �)e to 1 ? 26 9-
POP LIC EMAIL ADDRESS(If available) OCCUPATION(Do not leave blank) DATE OF BIRTH VOTER REGISTRATION VUID
1 �21J.'�r v'r r124�a ld�� Lo�l�' vCOc l :GAL e a&t NUMBER(Optional)2
Z003 70-/2Z-
TELEPHONE CON7 CT INFORMATION (Optional) LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN
Home: IN STATE IN TERRITORY FROM WHICH THE
OFFICE SOUGHT 15 ELECTED
Work:
year(s) 7 year(s)
Cell: q q U _600 - o O month(s) months) 7
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 I
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)„!�'�1 �__ f`s/j ►1Q� ',who being by me
here and now duly sworn,upon oath says:
"I, (name) t\-�,e_W T--C v, h of O r1 County, Texas, being a
candidate for the office of Dl 1r' 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 o 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 thi gs true and correct." \ �1tlJIM
4 U A �V
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SIGNATURE OF CANDIDATE n
Sworn to and subscribed before me at Der)Jo,ti T this the 12 day of ftli 2021 n
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nature of Offic ath4 Title of Officer Administering Oath
TO BE COMPLET I1' C Y OR SECRETARY OF BOARD:
(Sec.S"It"In 1, a7 s
V Date Received -,C/,3/ •M Signature of Secretary
Voter Registrati e
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