Treg A. BerntCITY OFFICE
PETITION FOR CANDIDACY
RECEIVED
AUG 2 4 2021
CITY OF (ate r�n,,wv�.
CITY CLERKS OFFICE
CANDIDATE FILING PERIOD p.c.50-4�0)
Opens: August 23, 2021 (8:00 am)
OFFICE INFORMATION
Filing for the Office of:
Clt Council Seat #
y
Closes: September 3, 2021 (5:00 pm)
_�-
CANDIDATE WITHDRAWAL DEADLINES (�.c. sa-�ao5a)
September 17, 2021 (5.•00 pm)
City Name:
Meridian
CANDIDATE INFORMATION
Candidate Name (As it will appear on the ballot.)
This petition must be filed in the office of the appropriate city clerk wifh the Declaration of Candidacy on or before 5:00 p.m. on
the last day of filing for the Election at which you are desiring to participate in. The submitted petition must have affixed thereto
the names of at least five (5) qualified electors which reside within the city.
SIGNERS STATEMENT
I, the undersigned, being a
qualified elector of the city listed above in the State of Idaho, do hereby
certify and declare that I reside at
a place set
oppos� 4�pynam_e, �nsl that I join in the petition of the candidate for
//VV �ler'j
the office listed above, to be voted for at
the election to be held on the ,�,
State
day of
Idaho
�K 2021,
and that each for himself says:
I have personally signed this petition; I
am a qualified elector of the of
and my
,
residence address is correctly written
after my name.
t nature of Petiti ner
Printed Name
Residence Address
Date Signed
1.
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CERTIFICATION
State of Idaho �.��
County of �/ /�
I, ,�I t �L:� l�" - t ! L��, being first duly sworn say: That I am a resident of the State of Idaho and at least eighteen (18) years of age: that every
person who signed this sheet of the foregoing petition signed his or her name thereto in my presence: I believe that each has sLt�cj�his or her name address
and residence correctly, that each signer is a qualified elector of the State of Idaho, and a resident of the county of /I l=�r}
Circulator i nature: � n
v
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Subscribed and sworn to before me this L�
Notary Signature:
Address:
�-�I `�.� j1r�Ui�r�
day of�rl5�' ,2-�2�.
Notary nnPu__lblic in and for the State of Idaho, residing at
My Commission Expires: g 1 `'%
23
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EC-38 -Petition for Candidacy for City Offices —Approved by the Idaho Secretary of State Revised osiili2o21
CITY OFFICE
CERTIFICATION OF CANDIDATE FILING TO COUNTY CLERK
CITY CLERK
Upon receipt of the Declaration of Candidacy along with the Petition of Candidacy:
1. Verify the qualifications of the Candidate.
2. Verify that the Petition of Candidacy is signed by not less than 5 electors and has been certified by the County Clerk's Office.
a. If the Petition of Candidacy was not verified by the County Clerk prior to submission to your office, deliver the
original petition to the County Clerk's Election Office to have 5 electors verified that they are properly registered electors.
b. If the electors are required to be residents within city limits, verify that the electors reside within the correct city limits.
3. Stamp or write the date and time of receipt on the front of the Declaration of Candidacy and Petition of Candidacy.
4. Complete the fields and statement below.
5. Transmit a copy of this Certification along with a copy of the Declaration of Candidacy to the County Clerk for ballot preparation.
CANDIDATE NAME BEING CERTIFIED TO THE COUNTY CLERK
Candidate Name (As it will appear on the ballot.)
OFFICE INFORMATION FOR BALLOT PLACEMENT
Filing for the Office of:
Clty COUnCI�
city Name:
Meridian
Term -length, seat or position
(if applicable):
Seat
CERTIFICATION
I Chris Johnson
certify that the qualifications of the candidate listed above 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 above and on the attached
�� .�
Declaration of Candidacy to be voted on at the Election to be held on the �-_—day of �l � l�•�P/l�% _ !� , 2021.
Signature of the Clerk or Represe
h',.
IMPORTANT
Dated:
1. Verification of the candidate's qualifications and the validity of the signers of the petition should occur immediately upon receipt of the
filing. This allows the candidate time to correct any errors in the filing.
2. Certification to the County Clerk should occur upon the verification of the candidate's qualifications and the validation of the signers of
the petition. To assist the County Clerk in ballot preparation, do not HOLD these until the last day of filing.
Revised 06/28/2021
CITY OFFICE
DECLARATION OF CANDIDACY
kECErvED
AUG 2 4 2021
., I I Y U r �iYl �J
!-I',' CLERKS OFFICE
CANDIDATE FILING PERIOD (�.c.50-a�oJ
Opens: August 23, 2021 (8:00 am)
Closes: September 3, 2021 (5:00 pm)
OFFICE INFORMATION
Filing for the Office of:
t✓Ity COUnCI� Seat #
CANDIDATE WITHDRAWAL DEADLINES (l.c. sa-�ao5ai
September 17, 2021 (5:00 pm)
City Name:
Mefldlan
CANDIDATE INFORMATION
Candidate Name (As it appears on your voter registration record.)
First �^ �
(��
MI
�.
Last ���
Suffix
Residence Address (As it appears on your voter registration record.)
Street Address
�� � � _ � (�u'�n� ��
City
�1L=Y�� �� �9
State
�(�
Zip Code
,�3�y Z
County
/ice
Mailing Address
Street Address
City
State
Zip Code
County
BALLOT NAME
Write your name exactly as you would like it to appear on the ballot
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
finance contributions or expenditures reach or exceed $500, I will create a Campaign Finance account with the Secretary of State, and may
at that time, appoint another person as Treasurer or remain as my own Treasurer.
CERTIFICATION
I, the undersigned, being a resident of the Stat f Idaho and of th �ci�Y liste above, do hereby declare myself a candidate for the office entered
above to be voted on at the Election to be held on the � day of Nl� li�l'�1 � t✓1Q , 2021 and I certify that the information on this Declaration is
true and accurate.
I further certify that I possess the legal qualifications to hold said office. I submit herewith the filing fee of ($40.00), or in lieu of the filing fee the
nominating petition containing the five (5) signatures of qualified electors as statutorily required.
Dated:
Subscribed and
Signature:
Notary Public in
Candidate
to before me thisday of �uC�.vc�sc' ,a"�.
the State of Idaho, residing at
— My Commission Expires: — -- ���Ea�� -
�'�� � O T A���'�'
a� COMMISSION �'�
A', No. 42bb3 ; r'
•
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EC-3A-Declaration of Candidacy for City Offices —Approved by the Idaho Secretary of State Revised 06/11/202i
CLfRK�S OFFICE
ELECTIONS
Phil McGrane, JD, MPA
Clerk of the District Cotn-t
Trent Tripple
Chief Deputy
400 N. Benjamin Ln., Ste. 100, noise, Idaho 83704 Phone (208) 287-6860 Fax (208) 287-6939
ADA COUNTY AFFIDAVIT OF
CERTIFICATION OF SIGNATURES FOR A CANDIDATE PETITION
State of Idaho, )
ss.
County of ADA)
To the Clerk of Meridian City, for the State of Idaho:
I, Phil McGrane, County Clerlc of Ada County hereby
certify that _7 signatures on this petition for
candidate Treg Bernt are those of qualified electors.
Phi Ile Ile COURT'''•,