Emmett, Joe, 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 1 15 If -P- M f f cP /k 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 nyymber or other distinguishing number, if any.)
C / Ca C I + /%A N - toti tC C/ t
' y
INDICATE,[
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TERM
FU LL
UNEXPIRED
FULL NAME (First, Middle, Last)
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PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOTI
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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.)
/37g4prd
PUBLIC MAILING ADDRESS (Campaign mailing address, if available.)
//
/ 3 0 7 , '6
CITY
A./ /t/ -v/ /e
STATE
T
ZIP
7 73rd
CITY
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STATE
ZIP
23Ye'
PUBLIC EMAIL ADDRESS (If available)
OCCUPATION (Do not leave blank)
et- reo-��,,,,41-t
DATE OF BIRTH
/ 3'i 17
VOTER REGISTRATION VUID
NUMBER (Optional) 2
IsP' Oil 61
TELEPHONE CONTACT INFORMATION (Optional)
Home: cj ,3 4-29/-17 3,6
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Work: 73‘ — 2
Cell:7
LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN
IN STATE
7 D year (s)
IN TERRITORY FROM WHICH THE
OFFICESOUGHT IS ELECTED3
/ li year (s)
month(s)
�J 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) —) 65 h /::~l �7-e-e , who being by me
here and now duly sworn, J)upon oath says:
"I, (name) 3d S h 6,41 1 f¢. of II/G, iiiere, CQf/,v'iti County, Texas, being a
candidate for the office of COL/A/c,/ //41-74.07-d Ct/Atei ,i , swear that I will suppdrt and defend the Constitution and laws
of the United States and of the State of Texas. 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 II things tru and
X-6-"S'
IGNATURE •FCIMInIneTF
Sworn to and subscribed before me at g- _J rQ , this the day of �,,,, MEGAN KALTENBACH
K
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Notinaublic
STATE OF TEXAS
COMM. EXP. MAR. 14, 2020
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Signat a of Officer Administering Oath4 Title if Offi ter Admir
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NOTARY ID 13066118.4rr
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TO BE COMPLETED BY CITY SECRETARY OR SECRET RY OF ARD: `f
(See Section 1.007) a-7 1-7
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Date Received
e o Secr:
.
Voter Registration Status Verified