In addition to the other statements and spaces for entering information that appear on an officially prescribed form for an application for a place on the ballot, each official form for an application that a candidate is required to file under this code must include:
(1) a space for indicating the form in which the candidate’s name is to appear on the ballot;
(2) a space for the candidate’s public mailing address;
(3) spaces for the candidate’s home and office telephone numbers and e-mail address at which the candidate receives correspondence relating to the candidate’s campaign;
(4) a statement informing candidates that the furnishing of the telephone numbers is optional;
(5) a statement informing candidates that knowingly providing false information on the application under § 141.031(a)(4)(G) constitutes a Class B misdemeanor; and
(6) a statement informing candidates that a candidate who indicates under § 141.031(a)(4)(G) that the candidate has been convicted of a felony must comply with the requirements of § 141.031(a-1).