HomeMy WebLinkAboutDeclaration of Intent as Write InRevised 06/11/2021
CITY OFFICE - WRITE IN
DECLARATION OF INTENT
CANDIDATE INFORMATION
Candidate Name (As it appears on your voter registration record.)
First MI Last 6Xႈ[
Residence Address (As it appears on your voter registration record.)
Street Address City State Zip Code County
OFFICE INFORMATION
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CERTIFICATION
I, the undersigned, being a resident of the State of Idaho and of the City listed above, do hereby declare myself a candidate for the
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information on this Declaration is true and accurate.
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Dated:Candidate Signature:
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Notary Public in and for the State of Idaho, residing at
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NOTARY
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OFFICIAL USE ONLY
CITY CLERK
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registration.
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COUNTY CLERK
Upon receipt of this Declaration of Intent, stamp the date and time of receipt on the front of this document.
Name, Title Date Time
CAMPAIGN FINANCE INFORMATION
I do hereby certify that I am a registered elector of the State of Idaho and appoint myself as treasurer for my campaign. If any campaign
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at that time, appoint another person as Treasurer or remain as my own Treasurer.
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