York Application for Place on the Ballot - 02/05/2020 2-21
Prescribed by Secretary of State
Section 141.031,Chapters 143 and 144,Texas Election Code
1/2017
ALL INFORMATION IS REgUIRED TO BE PROVIDED UNLESS INDICATED OPTIONAL RECEIVED
APPLICATION FOR A PLACE ON THE CITY OF DENTON,TEXAS GENERAL ELECTION BALLOT
TO:City Secretary/Secretary of Board FEB 0 5 7020
I request that my name be placed on the above-named official ballot as a candidate for the office indicated below. City Managelb I City
OFFICE SOUGHT(Include any place number or other distinguishing number,if any.) I e-
INDICATE TERN Secretary's Office
Ci t A
wVv 1.i 1 p\ kc, c-,-,\k — t L'r ❑FULL
❑UNEXPIRED
FULL NAME( first,Middle,Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT1
L•
CAVA CAIAA ,S Vo (1 \ L-1 c m, \(o r 1
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 /r+��
at which you receive personal mail and location of residence.) Z(C)—4' W 4,5t Va'IC C✓t.. U IA' t P
1101- West D c-l< St U to t ,t
CITY STATE ZIP CITY STATE ZIP
17e.lAtovt. 1 X 7-6 W l e v‘,toln 71, ' ZG t
PUBLIC EMAIL ADDRESS(If available) OCCUPATION(Do not leave blank) DATE OF BIRTH VOTER REGISTRATION VUID
�r I�\ ('5 0v\-vt @5 lr, /'t- . (' & CtikeI * NUMBER(Optional)2
l r lJ�t J�rw.� 0 LI / 71) / Ill
TELEPHONE CONTACT INFORMATION(Optional) LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN
Home: IN STATE IN TERRITORY FROM WHICH THE
OFFICE SOUGHT IS ELECTED3
Work:
Z year(s) 1 year(s)
Cell:
month(s) 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. 1/
Before me,the undersigned authority,on this day personally appeared(name) LI 6.4&., `o rK ,who being by me
here and now duly sworn,upon oath says:
"I, (name) LI am, YDrt/ of i7JA V{-
OV. County, Texas, being a
candidate for the office of Li b" i CpwAGi I QloaL S i 1( ' Li.i c 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 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 __ __ _
SIGNATURE OF CA'NDIs'
Sworn to and subscribed b is TIi?.2'%1I� -., this the day of 4ebo.4 °�.
�' -�r °� ii,z:-: . ' Nota �Public
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!� l..,IL IL A A If `rte' Comm.Ex.. -.1.7 2022
Si: .ure •fsffic Ad- ..eringyik Titl-1•fO -rAdm' stering Oath
TOB CO •LETED BY r S. RE Y c SEf;CY OF BOARD: �,(
(See Se •n 1.007) (04,„ Or 4 . /may ../ �p t- r
'j 'V� to Received nat re of Secr ry
Voter Registration Status Ve �t!