Loll, Clyde, ballot application, 7-23-182-21
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 JVOWn1 ic7e- GENERAL ELECTION BALLOT
TO: City Secretary/Secretary of Board ern/ oF )ik'?i5Y/ e2.e..--
Irequest that my name be placed on the above-named official ballot as a candidate for the office indicated below.
!request
OFFICE SOUGHT (Include any place number or other distinguishing number, if any.) 2
) I1),A1t5Vi Ile (-cC&ic 1 11-lLL/C1' e �6'S J
V
INDIC
E TERM
FULL
UNEXPIRED
FULL NAME (First, Middle
Lon
PRINT NAME AS YOU WANT APPEAR ON THE BALLOT'
Cly //J -I,/, 1
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.)
/763 (,11CA'tr5fl fl
PUBLIC MAILING ADDRESS (Campaign mailing address, if available.)
/3 k ��1 s L '�
CITY , /
Hi,-rlrv-i ttr`
STATE
i
ZIP
-773(10
CITY4,1134 LLQ
STATE
-74
ZIP
7734Q
PUBLIC EMAIL ADDRESS (If available)
ClydelDll fin @yahavcom�1et-crot
OCCUPATION (Do not leave blank)
of ONSES
DATE OF BIRTH
67 /0i /lg9i
VOTER REGISTRATION VUID
NUMBER (Optional)2
110E5 a 1q3a i
TELEPHONE CONTACT INFORMATION (Optional)
Home: 1'36 r ,eq /- Oi) lR 7
Work:
Cell:
LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN
IN STATE
G
0 year (s)
IN TERRITORY FROM WHICH THE
OFFICE SOUGHT I5 ELECTED3
13 year (s)
1 month(s)
3 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) Q.) a ig , T Lo 11 , who being by me
here and now duly sworn, upon oathsays: `
"I, (name) C / ‘4. .J L 4 ii of / County, Texas, being a
candidate for the office o , r5V1 (.L('; 1.6-i OIIf1C/C 11-7:11-14E S,4wear that I will support 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 all things true and correct."
X .,�
SIGNAT RE OF CANDIDATE
Sworn to and subscribed before me at 4r 13 pw. , this the o20ar s da of aaI , x1.1,a .
SEAL
vAl ►A A.;• _ /V044..
MEM CRAIG
Signature of Officer Administering Oath4 Title of Officer ..mi ister'n: • .th
-:: \ **WOW
MY*+
TO BE COMPLETED BY CITY SECRETARY OR SECRETARY OF BOARD: d I r
A3
T , -4. \r SPAN •
(See Section 1.007) I' c o -
Date Is.4ceived .ig ature . ecr. Voter Registration Status Verified