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210816 -- Marie-Anne Mousseau-Holland -- Candidate ApplicationR .ECEIVED ALL INFORMATION IS REQUIRED TO BE PROVIDED UNLESS INDICATE APPLICATION FOR A PLACE ON THE Cc. v'('\,c_.\ \ . TO : City Secretary/Secretary of Board 2-21 Prescribed by Sec retary of St at e Section 141.031, Chapters 143 and 144, Texas Election Code 1/2017 GENERAL ELE CTION BALLOT 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.) INDICATE TERM G ·~ Lo v t'\ c, : \ \:> l a..e e, !Stu LL Lt D UNEXPIRED FULL NAME (First, Middle, Last) PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT 1 /\flo u ~s 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.) · ·~ {-., Su1"\-e '"Z.0-3 8 STATE ZIP CITY 17 PUBLI~ EM~L ADDRESS {If available) OCCUPATION (Do not leave blank) DATE OF BIRTH MG.:<', -e ~ E Vl "1r £()Y'e.vieuf' \fJ C"MRJ'v)<0'1't+-r e fe,YJ -e,uts· ~;><;etS'.c C..h\\G\c.°':<e , v-Je ' STATE ZIP l X VOTER REGISTRATION VUID NUMBER (Optional) 2 TELEPHONE CONTACT INFORMATION {Optional) LENGTH OF CONTINUOUS RESIDENCE AS OF DATE APPLICATION SWORN Home : ~ IN STATE IN TERRITORY FROM WHICH THE .....-OFFICE SOUGHT IS ELECTED 3 Work: 1o_ year(s) 13_ year(s) Cell: '}_\ -12_ month(s) _Q_ month(s) If using a nickname as part of you r 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) {)fl cl r \ e -G. 0 n e Ho I\ <w d 'who being by me here and now duly sworn, upon oath says : "I, (name) MM\ t {~xW\..C, \\o u ~Vl c\ ' of 3-r c,,;-z. Cl') Ce u ,, ·~~ County, Texas, being a candidate fort.he office of (' '· t ~ <:.G v V\ C.i l . 'f \ e ... ( -t (., , swear that I will supp and defend the Co~sti~ution and laws of the United States and of the Stat of Texas . I am a c1t1zen of th e Uni t ed St ates eligible to hold such office under the conslllul1un 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 thing x TO BE COMPLETED BY CITY SECRETARY OR SECRET?Y OF BOARD: (See Section 1.007) ~·-I lo -..OD~I / Date Received Voter Re gistration Statu ~ Verified litr ISA F. MoQRACKEN Nota ry Pub!i r. • State of Texas ii.)# 1329 702 '-1 ·3 M Comm. Expires :l · 1 l ·2025