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140721 - Candidate Application - Karl P. MooneyAW2-20, 7/2011 Prescribed by Secretary of State Sections 141.031, Chapter 144, Texas Election Code AH information is required to be provided unless indicated as optional. APPLICATION FORA PLACE ON THE y ;'rc .t' yrs " GENERAL ELECTION BALLOT TO: 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 INDICATE TERM Include any place number or other t„airrtrisliin umher, i II t FULL UNEXPIREDiio Middle, Last) ANT IT TO APPEAR ON THE BALLOT PERMA NT RESIDENCE ADDRESS (Street address and apartment number. If none, describe location of residence. Do not include P.O. Box or Rtral Rt.) All.,IN(i AI)l7ldlitiS (lt difl rcrtt IrottN reside] CI 1 1' STATE ZIP 1!'MAll `AI3l)RItiSS (Optional) OCCUPATION (I;Io not leave blank TELEPHONE NI,T' 111 OFFICE: tl'^ DATE OF BIRTH COUNTY OF RESIDENCE Include area code) (Optional) Length of Continuous Residence as of Date Application Sworn HOME: 791 IN Art,. Yr(s) mos IN TIN Yr(s) mos IN DISI Itl(,:filOR PRECINCT yr(s) mos If using a nickname as part of your name to appear on the ballot, you are also signing and swearing to the fo lowing 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 conatnonly known by this nickname for at least three years prior to this election Before me, the undersigned authority, on this day personally app here and now duly swom, upon oath says: "I, (` p rra ` / who being by me County, Texas, being a candidate for the office of „,'rreS, , swear that I will support and defend the Constitution and laws of the United States an n oft e State^ of 1 ew is am a eitirctt 1'tlte 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." NAV ° l ! OF (::' ANI 11II:)ATE to ntd subscribed before -one at E)' Signature of (1 ' icr°r admi nc terinl, oath' this the t ....._.._ day of t'....... Title of Officer administering oath SHERRY MA ` H8URN' Notary Public, Sta of Texas My Cornmissio Expires JULY 26, 015 TO BE COMPLETED BY SECRETARY OF BOARD: See Section 1 007) Date Received