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191213 -- Application for Place on Ballot -- Marycruz DeLeon Morales RECEIVED DEC i 3 7f1 2-22 Prescribed by Secretary of State Section 14 1, t rs 143 and 144,Texas Election Code BY: 1'.1.. 1/2017 ALL INFORMATION IS REQUIRED TO BE PROVIDED UNLESS INDICATED OPTIONAL APPLICATION FOR A PLACE ON THE City c (�_,(( 5' y©✓1 SPECIAL ELECTION BALLOT TO:City Secretary/Secretary of Board 1 J 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.) C� k C. ec- r C;4-.1 Coovvi ll7k,acip Lf FULL NAME(First, Middle,LastP PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT' I'kt0..ry�C�r.�e- Morale-5 M cit)t.De,Le rt, 1 ,r0C.5 PERMANENT RESIDENCE ADDRESS(Do not include a P.O. Box or Rural PUBLIC MAILING ADDRESS(Campaign mailing address,if available.) Route. If you do not have a residence address, describe the address at which you receive personal mail and location of residence.) JO%O tU tom!rvt 4 -_)1>i CITY STATE ZIP CITY STATE ZIP c2 otk ? �E- 0 4 7 ( 7 7sct 5 PUBLIC EMAIL ADDRESS(If available) OCCUPATION(Donot leave blank) DATE OF BIRTH VOTER REGISTRATION VUID r Ml` A. )(/t II _ ., l _I-ifk LCG MCI "lam NUMBER(Optional)2 TELEPHONE Ni05,CT INFORMATION(Optional) LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN Home: IN STATE IN TERRITORY FROM WHICH THE OFFICE SOUGHT IS ELECTED3 Work: 7 j� year(s) ( year(s) Cell: ei 7�_ T ` Z -051'k I, month(s) y 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) (Af 1 uZ�[rLe CVI MO(&(r0 S ,who being by me here and now duly sworn,upon oath_says: —p 1 "I, (name) Mt �U'��peL.�t1 (oi&i e•S of GJij o Z.0j County, Texas, being a candidate for the office of(,;}y&CA S Jay�a` ucteit —Ple_t e_( ,swear that I will support and defend the Constitution and laws of the United States and of the State t>f Texas. I am a citizen 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 things true and writ-a." v X •IGNATURE OF CANDIDATE Sworn to and subscribed before me at iJ 0 It, \,this the \'3 iay o� a„b\� .` SSAL d;)&2C` _ � , 4,,►PY Py, USA Mc�220-8 Signature of Officer Administering Oath' Title of Officer Ad' . istering Notary Public,State of Texas by Commission FYpires TO BE COMPLETED BY CITY SECRETARY OR SECRETARY OF BOAR April7,2021 ,/ 1 (See Section 1.007) — r 3 —/9 — — - • Date Received ign ture ecretary Voter Registration Status Verified