2023-2024 NOTARIZED ROSTER FORM

Please fill out the following form. Download a copy of the .pdf version and ensure a notary signs it. Mail Membership Roster, Membership Applications and Membership Dues to Teresa Perez-Wisely, Treasurer, 909 Theresa Ave., Austin, TX 78703.

, as Chair/Treasurer of the Tejano Democrats

Chapter do hereby swear that the members whose names appear on the attached Tejano Democrats Chapter Membership Roster and Membership Application Forms are members whose membership dues are hereby paid and that the Voter Registration Number submitted is true and correct. I do hereby submit their names for membership of the State organization of Tejano Democrats and for recognition of members in good standing and all privileges of such be conveyed upon the Chapter and each

as Chair/Treasurer of the Tejano Democrats, I do hereby swear that the Officers whose names ARE listed below are Officers who were duly elected to represent its membership and the Chapter in all activities and business of the Chapter. Officer positions that do not have names

Tejano Democrats Notarized Roster Form

2022-2023 Tejano Democrats Chapter Officers

Tejano Democrats Notarized Roster Form

Certificate of Acknowledgment of Notary Public

and for said state, personally appeared

to me (or proved to me on the basis of satisfactory evidence) to be the person

whose name is subscribed to the within instrument, and acknowledged to me that

they executed the same in their authorized capacity and that by their signature on

the instrument, the person, or the entity upon behalf of which the person acted,

Tejano Democrats Notarized Roster Form

WITNESS my hand and official seal.

Notary Public for the State of

Tejano Democrats Notarized Roster Form