S.I.D. #2 CANDIDATE FILING FORM

For NON PARTISAN OFFICE

 

FILING DEADLINE:             July 20, 2009

 

 

 

I, the undersigned registered voter of _____________________________, ___________________________________,

                                                                                  Street                                           City

 

________, _________________ hereby request that my name ________________________________________________

Zip Code               County                                                                       (Print Name as it is to Appear on Ballot)

 

 

be placed on the official ballot for the election to be held the       8th   day   of   September   2009.

 

 

I am a candidate for the office of    Board of Trustees to Sanitary & Improvement District #2, as a

 

                                                                                                     for a term of Two years.

                   (Homeowner or Lot owner)

 

I HEREBY SWEAR THAT I WILL ABIDE BY THE LAWS OF THE STATE OF NEBRASKA REGARDING THE RESULTS OF THE ELECTIONS, THAT I AM QUALIFIED TO BE ELECTED, AND THAT I WILL SERVE IF ELECTED.

 

IN WITNESS WHEREOF, I have hereunto subscribed my name this _________ day of ________________, ____________.

                                                                                                              (day)                     (month)                     (year)

 

                                                                         ______________________________________________________________

Signature of Applicant

 

State of __________________  )

                                                   )  .ss

County of _________________ )

 

 

Subscribed in my presence and sworn to before me this ____________ day of ________________________, __________.

                                                                                                    (day)                             (month)                                         (year)

 

 

 

                (SEAL)

                                                                                       ______________________________________________________

                                                                                                                                Officer Administering Oath / Notary

 

 

                                                                                       _______________________________________________________

                                                                                                                                                     Title

 

 

__________________________________                 _______________________________________________________

   Business phone of Candidate (optional)                                                    Business Address of Candidate (optional)

 

 

MAIL COMPLETED FORM TO JOANN M. FISCHER, KNOX COUNTY CLERK, PO BOX 166, CENTER NE 68724 BEFORE JULY 20, 2009.      CALL 402-288-5604 IF YOU HAVE ANY QUESTIONS.