Kristen PudlowRECEWED
CT 0 7 201
Declaration of Intent for Write-in Candiddfog- x�V ;L- )-
CITY CLERKS OFFICE
I, r ttAC l s t t h the undersigned, do hereby declare my intent to be a write-in
candidate for the office of S s ' , for a term of years, to be voted for at
the election to be held on the 5th day of November, 2019, and that my residence address is
I further certify that I possess the legal qualifications to hold said office, that I am a qualified elector
of the City of Meridian, State of Idaho, and that I have es'de in the city for t least thirty (30) days.
11 �� 0
Dated: ~% �(' n���,- , 2 0 14 Signed:
Subscribed and sworn to before me this day of `
``. W g Signed:
Notary Public°in and for the State of Idaho
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(Notary Seal)
OFFICIAL USE ONLY
CITY CLERK
Before accepting this Declaration of Intent, the City Clerk (or designee) must verify that the person submitting this
declaration is a qualified city elector as defined in Idaho Code 50-402(c) and that the residence address provided
above matches the address on the individual's voter registration.
This declaration was accepted by5 ,
Name, Title
on - at
Date Time
A copy of this form must be transmitted to the County Clerk as soon as possible after it is filed.
COUNTY CLERK
Upon receipt of this Declaration of Intent, stamp the date and time of receipt on the front of this document.