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Armintor Application for 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 MIRED TO BE PROVIDED UNLESS INDICATED OPTIONAL APPLICATION FOR A PLACE ON THE CITY OF DENTON,TEXAS GENERAL ELECTION BALLOT TO:City Secretary/Secretary of Board RECEIVE® 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 numbe-or other distinguishing number,if any.) INDICATE T RMIt M 9 12020 11 �LL �1 1C-e— ❑UNEXP R It Manager's/City FULL eNAME(First,Mid-le,Last) PRINT NAME AS YOU WANT IT TO APPEAR O NT el1�v�1� N 2 r v� r� ✓ Q-b 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.) �.003 MSS�,.�uor�1 Lccr`� �0 0 L"Ar e— CITY STATE ZIP CITY STATE ZIP I 6z�1 TX PUBLIC EMAIL ADDRESS(If available) OCCUPATION(Do not leave blank) DATE OF BIRTH VOTER REGISTRATION VUID � NUMBER(Optional)2 TELEPHONE CONTACT INFORMATION(Optional) LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN Home: IN STATE IN TERRITORY FROM WHICH THE 2 OFFICE SOUGHT IS ELECTED Work: year(s) 1 year(s) Cell: OP q Q � 0 d �� month(s) .5month(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)4122e� ho being by me here and now duly sworn,upon oath says: "I, (name) of County, Texas, being a candidate f r the office of - 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 ful 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 c rrect." X SIGNATURE OF CA I .o ROSA A Sworn to and subscribed before me at this theo'� V day of 0 ary Public SjYQ�7 OF TEXAS IU .87G07" �A Comm.Exp.Mag3,20210 — ZL�2 Signature of Officer Ad ing th' Title of Offic r Administering Oath TO BE COMPLETED BY Q ECRE E RY.yOF BOARD: (See Section 1.007) LA- © Received Signature of Secretary Voter Registration Sta a 'l � Q