Loading...
Little, John S., ballot application, 2-29-162 -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 THE TO: City Secretary/Secretary of Board I request that my name be placed on the above -named CI'N of -iuto50 LL-�' SPECIAL ELECTION BALLOT official ballot as a candidate for the office indicated below. OFFICE SOUGHT (Include any place number or other distinguishing number, if any.) 1-u M T SO L- C TY Coin CI L AT- LA->e6E �5jllot-1 2 FULL NAME (First, Middle, Last) HTI S• t IrrLe PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT 3-0 H7-4 S L InLC PERMANENT RESIDENCE ADDRESS (Do not include a P.O. Box or Rural Route. If you do not have a residence address, describe the address at which you receive personal mail and location of residence.) 1 H 2• (� (LLOw, 1O PUBLIC MAILING ADDRESS (Campaign mailing address, if available.) 2 I t- LO U%3C- C CITY j - } ' v r-1-r5 V ) L LE STATE ZIP 1-7 z ( ) CITY I-FVN- t) I LL E STATE ZIP 77 3 zD PUBLIC EMAIL ADDRESS (If available) OCCUPATION (Do not leave blank) Sar EM at) vc -v0 DATE OF BIRTH 10 / ( / 6Z VOTER REGISTRATION VUID NUMBER (Optional) 1 /Doe `,39' iq, TELEPHONE CONTACT INFORMATION (Optional) Home: Work: Cell: LENGTH OF CONTINUOUS IN STATE / J NS year RESIDENCE (s) AS OF DATE IN TERRITORY APPLICATION ELECTED /_ year (s) SWORN FROM 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: !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) here and now\ duly sworn, upon oath says: "I, (name) ...�U J n, S. L IT LE , Al ,,11 11 --i 4-A S • L L I TL-f , who being by me Texas, being a and laws and laws of by other incapacitated or \/-3 Al4Lfi'2 _ County, candidate for the office of the United States this state. I have not official action. I have partially mentally incapacitated I further swear that the of 15vALECr-N C©hACI L Lice ojJ 1 , swear that I will support and defend the Constitution to hold such office under the constitution or had my full rights of citizenship restored probate jurisdiction to be totally mentally law, Chapter 573, Government Code. : true an corr-ct." i and of the State of Texas. I am a citizen been finally convicted of a felony for not been determined by a final judgment without the right to vote. I foregoing statements included in of the United States eligible which I have not been pardoned of a court exercising am aware of the nepotism my application are in all hin G UR 1 • Sworn o and subscribed �_�� . Si: ature of . icer A• before me at ■ die L... this th:, I i tday of V a as ..I_ IMO ►�- I finis -ji'-� • : �� 1mr lrlar , LEE ` N �� % \ , • STATE �"--.+,�- �df My Comm. DWARD ' ublic p F • S -•. Feb 19, 2017 G • z -- - ' : • ath Titl- of Officer Ad T ∎ BE COMPLETED BY CITY SECRETARY OR SECR (See Section 1.007) Voter Registration Status Verified ti • 7 , 30' lRP D: i �k n- : f�tuire of Secre Date Received _ i