Clanton Application for Place on the Ballot - 02/07/2020 2-22
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 City of Denton,Texas SPECIAL EL C7@A4gT
TO:City Secretary/Secretary of Board
I request that my name be placed on the above-named official ballot as a candidate for the office indicated below. FEB — 7 2020
OF ICE SOUGHT(Include any place number or other distinguishing number,if any.) City Manager's/City
�J Secretary's Office L "'/ ( 4.."r
7
FULL N E(Fi iddle,Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT
f JOIJ h:Z el (JU)
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.)
CITY STATE ZIP ITY STATE ZIP
PUBLIC EMAIL ADDRESS(If available) OCCUPATION(Do not leave blank) DATE OF BIRTH VOTER REGISTRATION VOID
NUMBER(Optional)2
TELEPHONE CONTACT INFORMAT N(Optional) LENGTH O CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN
Home:4/w ����f(I� IN STATE IN TERRITORY FROM WHICH THE
qrr OFFICE SqUGHT IS ELECTED
Work:'�r7)-—S-) '�Tyear(s) year(s)
Cell: 940 --Z31 S� �� _ month(") month(s)
If usinga 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) DCZ �/�i c4' , who being by me
here and now duly sworn,upon oath says:
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"I, (name) ffice t'� of f- ) -> y County, Texas, being a
candidate o of rL( �• � 2 swear that I will support and defend the Constitution and laws
of the United States and of the St 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 applicati a in all things true an�
SIGNATURE OF
Sworn to and subscribed before me a :i this the — day of ROSA A RIOS
NctRttblic
pf OE STATEsOF TEXAS
ID#Signature of Officer Adminis&rin^ ••^ "^^y y Comm.Ex��.Niay`23,2p�1
Si
g Title of Officer Administering Oath
TO BE COMPLETED BY CITY=EWtT E *ZF OARD:
(See Section 1.007)
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'•. Da Fj, eived Signature of Secretary
Voter Registration Status VeAlf q4 ^^••'I P\��