Bright, Michelle, ballot application, 7-27-172-21
Prescribed by Secretary of State
Section 141.031, Chapters 143 and 144, Texas Election Code
1/2017
ALL INFORMATION IS REQUIRED TO BE PROVIDED UNLESS INDICATED OPTIONAL
APPLICATION FOR A PLACE ON THE C�1ki n(' UuniSVII ILe GENERAL ELECTION BALLOT
TO: City Secretary/Secretary of Board
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.)
C)v Ccc\ i8
INDICATE
TERM
FULL
UNEXPIRED
FULL NAME (First,ir/Middle, Last) C
i `�(_`
PRINT
►{/NAME AS�YOU
-►WANT IT TO APPEAR ON THE BALLOT
�a lr
PERMANENT RESt\e ��D S (Ci
Route. If you do not have a residence
att which you receive personal mail and
VOri\-irl
n includea
address,
location
P.O. Box or Rural
describe the address
residence.)
3j,
PUBLIC MAILINGtADDS(Campaign m� g es available.)
W:-.)/1 �, 1 /
CITY
\\Uj\S\J t\ 1C
STATE
Tic
ZIP
773
CITY
ivlJ3 /i ti ie
STATE
ZIP
7 73V
PUBLIC EMAIL ADDRESS (If available)
ikes�'� mI@8M0.i�e �s�m
OCCUPATION (Do not leave lank)
'teak f 5 -6V e—
Satt5o5
DATE OF BIRTH
21 /1111E
V TER REGISTRATION VUID
NUMBER (Optional) 2
11g52q 2,193
TELEPHONE CONTACT INFORMATION (Optional)
Home:
Work: gss-y35 - 10.YD
Cell: 93(0_ r12n _ G2I (j R
LENGTH'BeF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN
IN STATE
year (s)
IN TERRITORY
OFFICE SOUGHT
L
FROM WHICH THE
IS ELECTED3
year (s)
8 months)
)
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) , r, tie tie 8r,-:30-- , who being by me
I
here and now duly sworn, upon oath says: r,
"I, (name) ' ftrI‘Ckt,(1� Ekt k , of lker County, Texas, being a
candidate for the office of Q, Inc 1 1 Wet( a, 1 , swear that I will support and defend the Constitution and laws
of the United States and of the State of T xas. 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 trr and correct."
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SIGNATURE OF
AN �,,•,�•_ 4 EE s s I ; • ...
Sworn to and subscribed before me at ‘ 1 ; lO m , this the . ` say o Tt
Said . ' NOTARY PUBLIC
:7-4- * ST ,OF TEXAS
gdolifillP MY COMM. EXP. 2/19/21
NOTARY ID 12681012-9
Signature of Officer Administering Oath4 Title of Officer Adminis ring Oath
TO BE COMPLETED BY CITY SECRETARY OR SECRET Y OF OARD:
(See Section 1.007) 1
__
Date eceive Si: a ure o Secr ary
Voter Registration Status Verified IX