Davidhizar, Paul ballot application, 1-25-162 -22
Prescribed by Secretary of State
Section 141.031, Chapters 143, 144, and 201, Texas Election Code
12/2015
All information is required to be provided unless indicated as optional.
APPLICATION FOR A PLACE ON
TO: City Secretary/Secretary of Board
I request that my name be placed on the above
THE L l'Ci O- i}utrtSv II_LE SPECIAL
ELECTION BALLOT
-named official ballot as a candidate for the office indicated below.
OFFICE SOUGHT (Include any place number or
Ctom( v NCI l_ NI--
other distinguishing number, if any.)
LM& e- DSi l lI cisi 1
F NAME (First, Middle, Last
u iC�+1 IJ l
P�v WW2--
PR NAME AS YOU WANT IT TO APPEAR ON THE BALLOT
L V i t2
AN -tdZ
PERMANENT RESIDENCE ADDRESS (Do not include
Route. If you do not have a residence address,
at which you receive personal mail and location
CAI 1-41LLCie3-v- De_
a P.O. Box or Rural
describe the address
of residence.)
PUBLIC MAILING ADDRESS (Campaign mailing address, if available.)
V32-- ELl!1NS LAKE
CITYY
t'C" S■1 \ I-Le-
STATE
I
X
ZIP
- '734
CITY
. J tZTSv 1 ice
STATE
—rX
ZIP
-77340
PUBLIC EMAIL ADDRESS (If available)
ACt‘fisa\'111qi'@ Q IN1C{t 1 s Cvrh
OCCUPATION (Do not leave blank)
'" Comks--
DATE OF BIRTH
o k / 2g / i l9i
VOTER REGISTRATION VUID NUMBERR((Optional)1 j
Ic o l CiCol l9S-
TELEPHONE CONTACT INFORMATION (Optional)
Home:
Work:
Cell: S 3C — C(02-35-1-7
LENGTH
OF CONTINUOUS
IN STATE
J 3 year
RESIDENCE
(s)
AS OF DATE
IN TERRITORY
APPLICATION
ELECTED
18 year (s)
SWORN
FROM
month(s)
5 month(s)
If using a nickname as part of your name to appear
that my nickname does not constitute a slogan
commonly known by this nickname for at least
on the ballot, you are also signing and swearing to the following statements: I further swear
nor does it indicate a political, economic, social, or religious view or affiliation. I have been
three years prior to this election.
Before me, the undersigned authority, on this
here and no my sworn, upon oath says:
l
"I, (name) \ NVINA%2
day personally appeared (name)
, of
1
Q�l.� clk, �� who
being by me
Texas, being a
and laws
and laws of
by other
incapacitated or
L4ci .. _ County,
candidate for the office
of the United States
this state. I have not
official action. 1 have
partially mentally incapacitated
I further swear that
of NutsTSim«r C,cY
CoaixlL Kr Warr cr ' i , swear
that I will support
to hold such
or had my
probate jurisdiction
law, Chapter 573,
g : and cor
•
41!...
and defend
office under
full rights
to be totally
Government
-
■
the Constitution
the constitution
of citizenship restored
mentally
Code.
and of the State of Texas.
been finally convicted of
not been determined by
without the right
the foregoing statements
I am a citizen of the United
a felony for which I have
a final judgment of a court
to vote. I am aware of
included in my application
X
States eligible
not been pardoned
exercising
the nepotism
a t
SIGNATUR: [j i . '
Sw. to an • subs
ribed before me at �L
• �.�„ this the . + day o Ta :�1
= J►�.i'i>1[ • N ',all blic ,
�� 't:
/� .. STA TEXAS
+era - ,* My Comm. Exp. Feb. 19, 2017
i
n.tureof 1 cerAdministerin: bath
Title' • icerAd
ini %-ring*'
O BE COMPLETED BY CITY SECRETARY OR SECRET
(See Section 1.007)
Voter Registration Status Verifie
Y OF Or D:
4
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Dat Received : =ture of Se • ary