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.)
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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.)
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\Azul livl`14 , 1`7 rf37o
PUBLIC MAILING ADDRESS (Cam iaign
1 Ns4,\\Q, ,\----4-1-31,0
CITY
\Avn2n.nsA4 -
mailing address,
STATE
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if available.)
ZIP
-4-.3-1.....
CITY
4\ 1\e
STATE
1-x
ZIP
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PUBLIC EMAIL ADDRESS (If available)
OCCUPATION (Do not leave blank)
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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
,
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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,
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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
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( 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 ,