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191219 -- Candidate Application -- David Fujimoto2-22 Prescribed by Secretary of State Section 141.031, Chapters 143 and 144 , Texas El ec tion Co de 1/2017 APPLICATION FOR A PLACE ON THE _C_i-\_1+--o_u..nc __ i_....l _______ SPECIAL 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 (Includ e any place number or other distinguishing number, if any.) c 0 u Y'IC-\' 0 ~ ( 0 \ \~j '2-. s..\-~--\-~on ) 'P \ a_c_e__ -ti-L\- FULL NAME (First, Middl e, La st ) PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT 1 Da" \A \.,Ja. ~ Fu· \mo +o PERMANENT RESIDENCE ADDRESS (Do not 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.) CITY STATE ZIP Co\\~ ~ S-\-a_ -\-i\)n \'I--17'6 4-S- Ctt.v\ ~ ruj\rv10+-0 PUBLIC MAILING ADDRESS (Campaign mailing address, if available.) CITY STATE ZIP Col\eje_ ~ct:hoY"\ Tf( 77cg'fs PUBLIC EMAIL ADDRESS (If available) OCCUPATION (Do not leave blank) DATE OF BIRTH VOTER REGISTRATION VUID NUMBER (Optional)2 J 9uj \ ~ S Q'ia..hoo .c.o"'"' De" e.-lo p~ 4!-n+ O~i c.e r I 2Io??1 G 1-~Cf TELEPHONE CONTACT INFORMATION (Optional) Home : LENGTH OF CONTINUOUS RESIDENCE AS 0 DATE APPLICATION SWORN Work :( ~11 J 4-Si -(;)G, ~I.\ ce11 {103 ) l\--3~ -ioq r IN STATE !i__ year (s) ~month(s) IN TERRITORY FROM WHICH THE OFFICE SOUGHT IS ELECTED 3 _!±__year (s) i;--month(s) If using a nickname as part of your name to appear on the ballot, you are also signin g and swearing to the following statements : I further swear that my nickname does not constitute a sloga n nor does it indicate a political, economic, social, or religious view or affiliation. I have been common ly known by this nickname for at le ast three years prior to this election. Before me, the undersigned aut hority, on this day personally appeared (n ame ) bavi d. f uj i WI o-tv here and now duly sworn, upon oath says: , who being by me of f) \f(A W S County, Texas, being a _ __.,.,.~-"+-_.__....__.._._.~~~=~-+----~swear that I will support and defend the Constitution and laws of the United States and of the Stat of 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 actio n. I have not been determined by a final judgment of a court exerc isin g probate jurisdiction to be totally mentally in capacitated or partially mentally incapacitated without the right to vote . I am aware of the nepotism law, Chapter 573, Government Code. Administering Oath TO BE COMPLETED BY CITY SECRETARY OR SECRETARY OF BOARD : /.j_ -I '1 -I Cf (S ee Section 1.007} Voter Registration Status Verified ~ Date Received