Hedspetch, Mader, ballot application, 8-16-172-21
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 OPTIO L
APPLICATION FOR A PLACE ON THE i,/by of HuV13VI ILLI 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 j-. Cudc/L /11EMB4R. E) 3
INDITE
TERM
FULL
UNEXPIRED
FULL NA (First, Middle, Last)
M, DERRM'4ct'�rasrETZ
PRINT NAME AS YOU WANT IT TO /lAPPEAR ON THE BALLOT'
/t1ADS- R- �``'IEDsiPETc w
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 receivepersonalmail and location of residence.)
6 02,2 AVE. M,
Hun V t lie- j �tXf�s ' 7320
PUBLIC MAILING ADDRESS (Campaign mailing address, if available.)
92 Z /1/7E
sy/a E / `ZAS
773,2
CITY i i
i m3✓l i c
STATE
ZIP
77320
CITY
r
qd V,k,
STATE
%X r
ZIP
773240
PUBLIC EMAIL ADDRESS (If available)
/t1ader4/./nMATIO
OCCUPATION (Do not leave blank)
%11-e-cl
DATE OF BIRTH
01 /oz /1?54.
VOTER REGISTRATION VUID
NUMBER (Optional)2
1001'70/89
TELEPHONE CONTACT INFORMATION (Optional)
Home: Ai/A_
fT
Work: N/A
Cell: �� /0 38 -3 933
LCJ
LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN
IN STATE
38 year (s)
IN TERRITORY FROM WHICH THE
OFFICE SOUGHT IS ELECTED3
5 year (s)
months
O
month s
0 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) INA8CL.rsv, pciA , who being by me
here and now duly sworn, upon oath says:
"I, (name) { t rh� QC of L'& cam\ County, Texas, being a
candidate for the office of Cif swear that I will support and defend the Constitution and laws
u Mem- In% -d 3 Pp
of the United States and of the Ste 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 all things true and c rrect."
SIGNATURE OF A !