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Rodriguez, Rico, ballot application., 8-20-182-21 Prescribed by Secretary of State Section 141.031, Chapters 143 and 144, Texas Election Code 1/2017 LL INFORMATION IC A TO BE PROVIDED UNLESS INDICATED OPTIONAL APPLICATION F �R A PLACE ON THE (---• VONSIWY,ThrASCAle 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.) �,p 03.5;1 -FULL W-} l0.1 Y' 03.5;1-Z INDIC E TERM "j IUNEXPIRED FULL NAME (First, Middle, Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOTS PERMANENT RESIDENCE ADDRESS (Doot 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.) 2.2c4 `w1v+e ‘ 1-- \Azul livl`14 , 1`7 rf37o PUBLIC MAILING ADDRESS (Cam iaign 1 Ns4,\\Q, ,\----4-1-31,0 CITY \Avn2n.nsA4 - mailing address, STATE 1- if available.) ZIP -4-.3-1..... CITY 4\ 1\e STATE 1-x ZIP '..)-"3Z.o PUBLIC EMAIL ADDRESS (If available) OCCUPATION (Do not leave blank) bb__ er.-"e01 DATE OF BIRTH VOTER REGISTRATION VUID NUMBER (Optional) 2 TELEPHONE CONTACT INFORMATION (Optional) Home: Work: Cell: d`^1) b . Z" _ 7 7j' 2 LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN IN STATE A year (s) IN TERRITORY FROM WHICH THE OFFICE SOUGHT IS ELECTED3 ' year (s) month(s) 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) CL3.' ..)-E-7 , who being by me here and now duly sworn, upon oath says: "I, (name) ?_.t Cook.O 6i -e?'" of 0.� County, Texas, being a , k.) candidate for the office of CD J' c,; l Mt r' \W e. 3 QQAi %-' 7, swear 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 this state. I have not been finally convicted of a felony for which I have not been pardoned or had official action. I have not been determined by a final judgment of a court exercising probate jurisdic partially mentally incapacitated without the right to vote. I am aware of the nepotism law, Chapter I further swear that the foregoing statements included in my application are in all things true and, x such office under the constitution and laws of my full righ • • tizenship restored by other 'on s se to • Ily mentally incapacitated or 5 F, Govern ent Code. ect." / SIGNAT., • E OF C D,,; �Y. LEl� MMOCDWARD >,' NOTARY PUBLIC Sworn o and subscrifaeNiefore me at X. 5 1 , this theDth_ day of 1, , ' • [Per.* . SIAM OF TEXAS 440 MY COMM. EXP. 2/19 NOTARY 101 ::11 �I ( 1. • 'i� _�• .'r Signa _ _ _ re o Officer Administerin: Oath4 Title of Offi er Ad iris ring Oa ,,.... TO B COMPLETED BY CITY SECRETARY OR SECRET: • Y OF OARD:.4 PIP Section 1.007) r ` Voter Registration Status Verified III Date eceiv d Sig a' re of Secreta ,