Humphrey, Tish, ballot application, 7-24-172-21
Prescribed by Secretary of State
•
Section 141.031, Chapters 143 and 144, Texas Election Code
1/2017
ALL INFORMATION I5 REQUIRED TO BE PROVIDED UNLESS INDICATED OPTIONAL
APPLICATION FOR A PLACE ON THE C ZNry o- \Ak
ur sv- GENERAL ELECTION BALLOT
TO: City Secretary/Secretary of Board 1
I request that my name be placed on the above-named official ballot as a candidate for the office indicated below.
OFFICE SOUGHT (Include``any place number or other distinguishing number, if any.)
. ^t-% COU C> C : \ 0.r(k
INDICATE
/
TERM
FULL
UNEXPIRED
FULL NAMEt(First, Middle, Last)
L *; -'t o. . \--k ,, c., Ong' e
PRINT NAMEASYOU WANT IT TO APPEAR ON THE BALLOT1
/ / s k,icin e\A ce cj
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.)
3DS rocesv Lark -e_
PUBLIC MAILING ADDRESS (Campaign mailing address, if available.)
CITYSTATE
Q4AsvtIke
T
ZIP
-7340
CITY
STATE
ZIP
PUBLIC EMAIL ADDRESS (If available)
--Fish TeOf a `\��-�ii
.
a("":" COM
OCCUPATION (Do not leave blank)
Lu CJes 4,-aSes
Owntec
DATE OF BIRTH
6 /,27 / 6.0\•O\
VOTER REGISTRATION VUID
NUMBER (Optigo�nal)2 apl�
Lo$$$6n
TELEPHONE CONTACT INFORMATION (Optional)
Home:
Work: '1 3 S O O
Cell:
LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN
IN STATE
� year (s)
IN TERRITORY FROM WHICH THE
OFFICE SOUGHT IS ELECTED31 co z
- ' 5 year (s)
1 month(s)
5 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.
Before me, the undersigned authority, on this day personally appeared (name) L Q.:- \-- . V IA\ fC: , who being by me
here and now duly sworn,%orupon oath says: \ 1 ` ` V lJ
"I, (name) ' ' 5 \ j 1 V Mv`tce , of `'.-' �'-\\<er, County, Texas, being a
candidate for the office of C.. Couc‘41:\ U VJ asak7 , swear that I will support and defend the Constitution and laws
of the United States and of the State ofiexas. I.am a citizen of the United States eligible to hold such office
this state. I have not been finally convicted of a felony for which I have not been pardoned or had my full
official action. I have not been determined by a final judgment of a court exercising probate jurisdiction
partially mentally incapacitated without the right to vote. I am aware of the nepotism law, Chapter 573, Government
I further swear that the foregoing statements included in my application are in all things true and correct."
X -7-7sA
under the constitution and laws of
rights of citizenship restored by other
to be totally mentally incapacitated or
Code.
51 NATURE 01,
NDID
�� �/►�
Sworn to and subscr''ed before me at , this the ZI day of /
KALT
II
1 �1�. I�wI� ,�� ��L11� PQJt""
MEGAN
���tVA SEAL Nota ry Publ
i ! STATE OF
•�MM.EXRMAR.1
�� �. "�"it
a
ignatu • of Off a A. ministering Oath Title oflOffice
g g
Ad I eringO. h
t
oF
OTARY ID 1306E
TO BEMPLETED BY CITY SECRETARY OR SECRETARY
(See Section 1.007) �
OF OARD: V 4
°�;y a()i 1 i.: -
-
Date
Voter Registration Status Verified
_
�eceiv d S': :ture of Secretary �
ENBA
TEXAS
4,'41
11(1-z