CANDIDATE FILING FORM
For NON PARTISAN OFFICE
State
of
) .ss
County
of _________________ )
FILING DEADLINE: July 26, 2010
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 (See Reverse Side
for Information)
be placed on the official ballot for the election to be held
the 14th
day of September
2010.
I am a candidate for
the office of Board of Trustees
to Sanitary & Improvement District #1, ___________________________
(Homeowner or
for a term of Two years.
I HEREBY SWEAR THAT I
WILL ABIDE BY THE LAWS OF THE STATE OF
IN WITNESS WHEREOF, I
have hereunto subscribed my name this _________ day of _______________________,
____________.
(day) (month) (year)
____________________________________________________
Signature
of Applicant
Subscribed in my
presence and sworn to before me this ____________ day of
________________________, _______________.
(day) (month) (year)
(SEAL) ____________________________________________________
Officer
Administering Oath
____________________________________________________
Title
__________________________________ ____________________________________________________
Business phone of
Candidate (optional) Business
Address of Candidate (optional)
MAIL COMPLETED FORM TO JOANN
M. FISCHER, KNOX