Bayne, William E., ballot application, 8-17-182-21
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 e#7 e r /j�jti&V,/t 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.) //
n
C _ � ., / C , ,,V(f/4�- /�/ ) ? * Qnf 2
INDICATE
/
v'FULL
TERM
UNEXPIRED
FULL AME (First, Middle, Last)
PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT'
Aikj/kefilf & ZIA/Z.
PERMANENT RESIDENCE ADDRESS ( o not nclude 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.)
230/ &J -4x v &»v
PUBLIC MAILING ADDRESS (Cargpaign mailing address, if available.)
888 Elithv5'4
CITY / �,JJ, //���� STATE/
Wai,/W' 1- _p
ZIP
7
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CITY
STATE
iX
ZIP
��i%�
���rlJIZJ
PUBLIC EMAIL ADDRESS (If available)
OCCUPATION
�NUMBERr
��
4 j��-
(Do not leave blank)
DATE OF BIRTH
_07 1/7 4/7
VOTER REGISTRATION VUID
(Optional)2
ii1VNA074
TELEPHONE CONTACT INFORMATION (Optional)
LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN
Home:
Work:
IN STATE
341 year (s)
IN TERRITORY FROM WHICH THE
OFFICE SOUGHT I5 ELECTED3
51 year (s)
Cell:
O month(s)
t 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) 4_//%//4//'f cJAfAI , who being by me
here and now duly sworn, upon oath says:
"I, (name) . 1,L — / , of d! - County, Texas, being a
candidate for the office of / Cc/ of . ,j` ..* " AA) , swear that I will support and defend the Constitution and laws
of the United States and of the tate of Texas. 1 am a citiof 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."
XsC
'mow, f / ,i
FF WOODWARD
SIGNATURE OF r-
ti NOTARY PUBLIC
Swo f to and subscribed
before me at Illbo "jk. this the r)141 day of ci90`f
:; * STATE OF TEXAS
,t di' MY COMM. EXP. 2/19/21
NOTARY ID 12681012-9
(_ ,1�L
/ —._
Sig a ure of Officer Administering Oath° Titl:. •' icer Ad ini tering Oath
TO BE COMPLETED BY CITY SECRETARY OR SECRET\RY OF
BOARD: >
( •e Section 1.007) eU Li
)% i #. . . "'�
Date Received
Voter Registration Status Verified
Si ature of Secretary