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FOR THE OFFICE OF Ill e6r .IcA/i C.ik� itiU nc r� t Sunt 5
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1, the uA undersigned, being a resident of d`r_, County, State of Idaho,
registered and affiliated with the IR Q-JLN0. L- n Party, do hereby declare myself to be a
candidate for the office of n L, ` g"k 5 to be voted for at
the Primary Election to be held on the B*day of-lbtap;-i0i3•and that my residence address is
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I further certify that I possess the legal qualifications to hold said office.
Date: OS St� /3 Signed
Subscribed and swom to before me this s'k& day of f len 6e r 2 �l3
9ee1)N Signed
�pSQN a Notary Pu is
�.( Residing at 39-79 N. Wer -/,A A/V Merd�t✓ /6636yG
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INSTRUCTIONS
CANDIDATE: This Declaration of Candidacy must be accompanied by either the $40.00 filing fee or the
Petition of Candidacy signed by not less than 5 electors of your specific district or County. It must also be
submitted to the County Clerk during candidate filing between February 27a' and March 9"i, 2012.
COUNTY CLERK: Upon receipt of this Declaration of Candidacy:
1. Verify the Candidate is registered and is affiliated with the party designated above.
2. If the candidate submits the Petition of Candidacy with this Declaration, verify that the Petition is
signed by not less than 5 electors.
a. Verify that the 5 electors are properly registered electors.
i. If the electors are required to be residents of the candidate's sub -district, verify that
the electors are in the correct sub -district.
3. Stamp or write the date and time of receipt on the front of this document.
4. Complete the statement below.
I, J A UCP e_ 1�i m d� CAJ C�certify that the qualifications of the candidate have been verified,
including1the validity of the electors sign the Petition of Candidacy, and that the individual meets the
requirements to run for the office indi don the Declaration of Candidacy.
)eu it tIcrk or Deputy Clerk
Cit
EC -10. Declaration of Candidacy for Candidates for County Offices, Approved Secretary of State. December 2011
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Date