Declaration of Candidacy Moberly Seat 5 WithdrawnDeclaration of CandidacyQ
I, the undersigned, affirm that I am a qualified elector of the City of �lN l tl lat, , State of Idaho, and
that I have resided in the city for at least thirty (30) days. I hereby declare myself to be a candidate for the office of
IMS U for a term of years, to be voted for at the election to be held on the S
day of November, 2,013 , and certify that I possess the legal qualifications to fill said office, and that my
residence address is 3 o3 -( W& w k L
3G
Candidate's Signature
Subscribed and sworn to before me this Q7(o day of Q�b1s
w « .0.;�9,��'•. Signed �o
.• •. �'
�f NOTq
Rp S = Notary Public in and for the State of Idaho
pull LlG '� residing at
"R
OF E My Commission expires
__ '4 .bnwnna�s
m
I— cz:� OFFICIAL USE ONLY
CITY CLERK
Before accepting this Declaration of Candidacy, the City Clerk (or designee) must verify:
This declaration is accompanied by:
V/ The attached Petition of Candidacy signed by at least five qualified city electors with the attached verification
from the county clerk,
MA
A nonrefundable riling fee of $40.
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 onthe individual's voter
registration. 1 p' • ' 1
This declaration was accepted byJ�+uCC� 1-i� I rr.2L4n�
Name, Title
on 63 at 3 • S� pm .
ate Time
After the close of the candidate riling period, a copy of this form must be transmitted immediately to the County Clerk to
assist in ballot preparation.
COUNTY CLERK
Upon receipt of this Declaration of Candidacy, stamp the date and time of receipt on the front of this document. This
document is to be used for ballot preparation.
DECLARATION of CANDIDACY
For
-TPlease print name l exactly as/you wish it to appear on the ballot.)
F C i
FOR THE OFFICE O� , vi' LI I /- Se A4 g-
1,
I, the undersigned, being a resident of Ctty 7r �04-d 16?k District,
State of Idaho, do hereby declare myself to be a candidate for the office of C CpIAh(A I
for a term of 2 years, to be voted for at the Election to be held on the S
day of /udWi v%6C4— , 2-013 and that my residence address is3 00,3 W Seth ( (.tGy
f'lo.,4 all, 10 s33 La
I further certify that 1 possess the legal qualifications to hold Id offic
Date: 19�LZ& , Z.m 13 Signed
Subscribed and avM 1#0!%fDre me this t -D6 day of'10 a�013
(Noy '�. �+Y '•., Signed �(i e [� ��a �rD ry
OTAR �•�, Notary Public
ti
s
Residing at�_�
IBLIG Commission Expires c2q gDp 1s
•'%. of �o:.�•'' INSTRUCTIONS
CANDIDATE: This Declaration of Candidacy must be accompanied by the Petition of Candidacy signed by
not less than 5 electors of your specific district or zone. It must also be submitted to the Clerk of the District no
later than the last day of candidate filing.
CLERK OF THE DISTRICT: Upon receipt of this Declaration of Candidacy:
1. Verify that the Petition of Candidacy is signed by not less than 5 electors.
2. If the Petition of Candidacy was not verified by the County Clerk prior to submission to your office,
contact the County Clerk's Election Office to verify that the 5 electors are properly registered
electors.
a. If the electors are required to be residents of the candidate's zone, verify that the electors are
in the correct zone.
3. Stamp or write the date and time of receipt on the front of this document.
4. Complete the statement below and transmit a copy of this Declaration of Candidacy to the County
Clerk for ballot preparation.
1, , certify that the qualifications of the candidate have been verified,
including the validity of the electors signing the Petition of Candidacy, and that the individual meets the
requirements to run for the office indicated on the Declaration of Candidacy.
Signature of the Clerk of the District Date
COUNTY CLERK: Upon receipt of this Declaration of Candidacy, stamp the date and time of receipt on
the front of this document. This document is to be used for ballot preparation.
EC -1 A, Approved Secretary of State, January 2011