Meltzer Application for a Place on the Ballot - 01/21/2020 2-21
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 GENERAL ELECT'
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
1 ( p {� _ i City Man
1 L �GJ�.� 1"�t�ti�J - I W ',LtCt - ❑UNEXPIRE Secreta�Office
FULL NAME(First,Middle,Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT'
1�L.J� -�)C%.q�3 m,(b'e-- P('.'J� ,► ,fi r
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, descr;be the address 14 I 0 C'
at which you receive personal mail and location of residence.)
CITY STATE ZIP CITY STATE ZIP
PUBLIC EMAIL ADDRESS(If available) OCCUPATION(Do not leave blank) DATE OF BIRTH VOTER REGISTRATION VUID
NUMBER(Optional)z
TELEPHONE CONTACT INFORMATION(Optional) LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN
Home: IN STATE IN TERRITORY FROM WHICH THE
OFFICE SOUGHT IS ELECTED
Work: I
c., year(s) �year(s)
Cell:
S month(s) 3 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) (AV 1 Pt, �'� who being by me
here and now duly sworn,upon oath says:
"I, (name) +�-\ 11 z of e`mil0 County, Texas, being a
candidate for the office of ' l .r. Al- 04 swear that I will support and defend the Constitution and laws
of the United States and of the St to 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 �� L
SIGNATURE OF C
Sworn to and subscribed before me at - � this the day of PARKER
.�* hwsk Public
� 'o. _�,, STATE�F TEXAS
EN ,ba ID#125830537
l l `°' Comm.Exp.Sept.7,
Signat e o fficer Administ ath4 ' Title of Offi Admin' ering Oath
TO BE OMP ETED BY CITY S A A BOARD:
(See Sec .n 1.007) D1!
ate ed Signature of Secretary
Voter Registration Status Ver Q
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