Rodriquez, Joe, ballot application, 7-25-172-21
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
TO: City Secretary/Secretary of Board
I request that my name be placed on the above-named
THE C+ /7 04 1-lu,.nsvi)le 7 GENERAL
ELECTION BALLOT
below.
official ballot as a candidate for the office indicated
OFFICE SOUGHT (Include any place number or other distinguishing number, if any.)
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ri n%/ 4511 i 1 1 e -Te xAS
INDIC
E TERM
FULL(
UNEXPIRED
I
FULL NAME (First, Middle, Lasst)
SosL c P. Po r i Qt} e Z.-
PRINT NAME AS YOU WANT1IT TO APPEAR ON THE BALLOT'
Sue— Roth I Q) c 2.—
PERMANENT
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.)
cf03 _INt,1)oud bY'ivL
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PUBLIC MAILING ADDRESS (Campaign mailing address, if available.)
/ /
96 it- E/1(l,/S LA k -L
rl.SV/ / ��> / ..e `7
vn}x44S 739.0
CITY )
//I/ P.) i- V i 1 e-
STATE
TX
ZIP
7734-D
CITY
IivN -Is v;) le_
STATE
TX
ZIP
77.3 Y -D
PUBLIC EMAIL ADDRESS (If available)
OCCUPATION (Do not leave blank)
12 e- i e A
DATE OF BIRTH
1( /2s /9-7
VOTER REGISTRATION VUID
NUMBER (Optional)2
1108 L/ -'t'0 s3
TELEPHONE CONTACT INFORMATION (Optional)
Home: 536 _ y.35 _ / 2..y. g
7OFFICE
Work:
Cell: q2 6- 5 1_ 4'11 9
LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN
IN STATE
`
year
(s)
IN TERRITORY
FROM
SOUGHT IS
/Z year (s)
WHICH THE
ELECTED3
-3 month(s)
7 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)
here and now duly sworn, upon oath says:
"I, (name) To_c/_ P. Pude Quo, ._. , of
n
Sos r_/� Pods', Z- , who
being by me
Texas, being a
and laws
and laws of
by other
incapacitated or
/A.,4 )h., County,
candidate for the office of C;,t `cJot . ( /ht. o bit - Ward y- , 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 and correct."
of the United States and of the State of Texas. I am a citizen of the United
this state. I have not been finally convicted of a felony for which I have
official action. I have not been determined by a final judgment of a court
partially mentally incapacitated without the right to vote. I am aware of
I further swear that the foregoing statements included in my application
C-"" "\
States eligible
not been pardoned
exercising
the nepotism
are in all things
AT
, . ,
Sworn to and subscribed before me --► r UJ i3`!\, this the ay of
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STATE OFT�043
MY COMM. EXP.2
N NOTARY ID 12681012-9
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Sig t re of Officer Administering Oath4 Title of.O er A mi istering
th
BE COMPLETED BY CITY SECRETARY OR SECR
(See Section 1.007)
Voter Registration Status Verified1
Y,f BOARD: i
" 7 ' (3i I 1 /f �
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Da Received S n ure of Secretary