Davis, Timothy, ballot application, 8-4-172-21
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.)1.4-4/ OF I4vJ6V 1/1e 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;444 NC+ t 5e,t+ VVQr.&
INDICATE
NFULL
TERM
FULL
UNEXPIRED
FULL NAME (First, Middle, Last).PRINT
ari s (jl Ds
17/4041 �w
NAME AS YOU WANT IT TO APPEAR ON THE BALLOT'
—17-A40-41 '( a des G,,,1 bmis
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.)
1822_ Awe woe 0,
PUBLIC MAILING ADDRESS (Campaign mailing address, if available.)
(S22... A je,Ove 3
i
CITY j IIu `L_v ilk
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STATE
1)(
ZIP
773,10
CITY
i►I�
STATE
TX
ZIP
—775L10
PUBLIC EMAIL ADDRESS (If available) •
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OCCUPATION Q(Do not leave blank)
FeN C,e W 1 %;4 q
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DATE OF BIRTH
0'7 / 2'7 /1488
VOTER REGISTRATION VOID
NUMBER (Optional) Z
//tt3 77446 33
TELEPHONE CONTACT INFORMATION (Optional)
Home:
Work:
Cel1030 662.. 6096
LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN
IN STATE
29 year (s)
IN TERRITORY FROM WHICH THE
OFFICE SOUGHT IS ELECTED3
1 year (s)
0 month(s)
6 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.
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Before me, the undersigned authority, on this day personally appeared (name) tE'1�r,y. C C) VQ' `S , who being by me
here and now duly sworn, upon oath says: ('� 4Q
"1, (name) 11 t& � L }.V'tS of ��,\\k� County, Texas, being a
candidate for the office of � ( CNc;` Sad- `•iar� 1 , swear that I will support and defend the Constitution and laws
of the United States and of the Statd 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, Chap er 573, Government Code.
1 further swear that the foregoing statements included in my application are in all ings true a • orrect."
X'► -..-----""
SIGNATURE OF CANDIDATE
Sworn to before rCtx F dna the `�1 day �) a0c
and subscribed me at nt_ig.[1'this of ,
Neytan
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/
'j
Y_ ,
seityPublic
State of Texas
% •:' Notary IDN 12911708-9
Signature of Officer Administering Oath4 Title of Officer Adm i ring all
a
Exp. 09/16/202
TO BE COMPLETED BY CITY SECRETARY OR SECR IjY,
(See Section 1.007) y
RD:
—
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Dat Received Si n ure of Sec etaY ry
Voter Registration Status Verified )4'