Ferrie Application for a Place on the Ballot - 02/13/2020 2-22
Prescribed by Secretary of State
Section 141.031,Chapters 143 and 144,Texas Election Code
ALL INFORMATION IS REQUIRED TO BE PROVIDED UNLESS INDICATED OPTIONAL 1/2017
APPLICATION FOR A PLACE ON THE City of Denton,Texas SPECIAL EL 7BAL
TO:City Secretary/Secretary of Board REI request that my name be placed on the above-named official ballot as a candidate for the office indicated below. I
OFFICE SOUGHT(Include ny place numb r or other distinguishing number,if any.)
V,� ` City Manager's I Gity
Secretary's Office
Fu NAME(First,Middle,Last) PRIN AME AS YOU WANT IT TO APPEAR OBALMY
PERMANENT RISIDENCE ADDRESS(Do not include a P.O.Box or Rural PUBLIC MAILING AFD ESS(Campaign mailing address,if available.)
Route. If you do not have a residence address,describe the address
at w 'ch yo receive personal mail and location of residence.)
IURM
CITZ' STATE ZIP C11 STATE ZIP
171
PUBLIC EMAIL ADDRESS(If available) OCCUPATION(Do not leave blank) DATE OF BIRTH VOTER REGISTRATION VUID
�(�b @�e F C �` ` `„ `\ �M 1(� Q' NUMBER(Optionalf
TELEPHONE doNTAer INFORMATION(Optional) dENl OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN
Home: IN STATE IN TERRITORY FROM WHICH THE
Work: OFFICE SOUGHT IS ELECTED3
year(s) year(s)
Cell:
month(s) month(s)
It 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) who who being by me
here and now duly sworn,upon oath says:
"I, (name) K9 of �_f��i> County, Texas, being a
candidate for the office of ,� i swear that I will support and defend the Constitution and laws
of the United States and of the§tate 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 al I things true and correct."
X -
S NATUREOF
M
Sworn to and subscribed before me a D.' this the `day of NSTAI Com
Signature of Officer Administering_Ok,4°'1 ••••••••••.• T��i Title of Officer Admini ering Oath
TO BE COMPLETED BY CITY SECRE$k1&.0't SE TAR1A CARD:
(See Section 1.007) / L =—
_ ecfJvid•; Signature of Secretary
Voter Registration Status Verif At UCl t j
n .
s •.• co ZI