Davis, Timothy Charles Owl, 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 I5 REQUIRED TO BE PROVIDED UNLESS INDICATED OPTIONAL
APPLICATION FOR A PLACE ON THE 0.,;'Y O4. eta,..A.s.lit 20 IA 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.)
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INDICATE
TERM
FULL
UNEXPIRED
FULL NAME (First, Middle, Last) V
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PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT'
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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.)
(L2 AVeuve 0
PUBLIC MAILING ADDRESS (Campaign mailing address, if available.)
/48 2 ,,Care Nine 0
CITY
/4044,...1\3Ale
STATE
Ty,
ZIP
i7 340
CITY
1,4v itle
STATE
7x
ZIP
773 L c
PUBLIC EMAIL ADDRESS (If available)
Le kerooaccafc e yea � xdi1
OCCUPATION (Do not leave blank)
Self r AP ^�1, ,A _
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DATE OF BIRTH
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VOTER REGISTRATION VOID
NUMBER (Optional) 2
11 43 77 qS 33
TELEPHONE CONTACT INFORMATION (Optional)
LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN
Home: 9 36 4s2 gp9
Work: (L I I
IN STATE
Z year (s)
IN TERRITORY FROM WHICH THE
OFFICE SOUGHT I5 ELECTED'
Z year (s)
Cell: / ( ( 1.
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.•
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Before me, the undersigned authority, on this day personally appeared (name) //MCfI �l�(( 4r1tf C i
I )1S , who being by me
here and now duly sworn, upon oath says: 1
•
"I, (name R4T S - t U i , of 7/0a./ kg It- County, Texas, being a
•
candidate for the offic • . . _ _.. swear that I will support and defend the Constitution and laws
of the United States and of the State of Texas. I am a c 'zen 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 th' gs true and c rect.”
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-3---NATURE OF CP
; ` LEE BARD
NOTARY PUBLIC
Sworn to and subscrib: • before me at a • ' _L this the day of •
I', *
STATE OF TEXAS
111
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MY COMM. EXP. 2/19/21
NOTARY ID 12681012-9
Sig
ure of Officer Administering Oath Title O icer Admini Oa
BE COMPLETED BY CITY SECRETARY OR SECRET Y OF
"ring
BOARD -
(See Section 1.007) %
1 '
Date Received CSi n ture of Secre
Voter Registration Status Verified