HomeMy WebLinkAboutA004 - Affidavit of Candidacy - Annette Jensen Form 2-M(Rev.95)[45.3]
Prescribed by the
Iowa Secretary of State
STATE OF IOWA
AFFIDAVIT OF CANDIDACY
School and City Elections
For the office of Ames City Council , Fourth Ward
(Include district number,if any)
❑ Check here if election is to fill a vacancy.
Date of Election: November 7 , 1995
Name (exactly as you want it to appear on the ballot):
Annette L . Jensen
Home Address: 1226 Idaho Ct .
City and Zip Code: Ames , IA 50010
County: Story
I swear or affirm that the information I have provided above is correct. I am a candidate for the office indicated
above and request that my name be printed on the official ballot for this election. I am eligible to hold the office for which
I am a candidate; if I am elected I will qualify by taking the oath of office. I know that I cannot hold a public office if I have
been convicted (and never pardoned) of a felony or other infamous crime.
I know that I am required to organize a candidate's committee which shall file an organization statement and
disclosure reports if my committee or I receive contributions, make expenditures, or incur indebtedness in excess of five
hundred dollars ($500) in a calendar year for the purpose of supporting my candidacy for public office. [This paragraph
does not apply to candidates for federal offices.]
know that I cannot be a candidate for more than one office to be filled at this election. If I have filed nomination
papers for more than one office I must file with the officer who accepted my nomination papers an affidavit indicating for
which office I choose to be a candidate. I understand that if the affidavit is not filed by the last day candidates can file
nomination papers, I cannot be a candidate for any office on the ballot at this election. [This does not apply to county
agricultural extension council, soil and water conservation district commissioner, or regional library trustees.]
Signed: l l_�tb'lx #e(I, I d-,
�—�� � \\__ J
Signed and sworn to (or affirmed) before me onntc:m�S`,�,t �Cl i (date) by
n, "-- (print candidate's name).
Signature of Notary Public(or ther oi�cer a orized to witness oaths)
Official Title: C��c, l" lF i_� tY� :t
My commission expires:
Form 59 ,AA,T PARROTT&SOUS CO WATERLOO.IOWA D35 0-559 (Revised July 1990)
(Chapter 45,code of Iowa)
STATE OF IOWA
Nomination Petition
For Nonpartisan Nominations and Nonparty Political Organizations
For the office of Ames City Council , Fourth Ward
I, the undersigned eligible elector of the State of Iowa, City of Ames , Ward 4 do hereby
(If applicable,district or other division)
nominate Annette L. Jensen of 1226 Idaho Ct . , Ames Iowa,
(Name of candidate) (Address)
as a candidate of for the
(Name of nonparty political organization,if any)
office of Ames City Council , Fourth Ward to be voted for
at an election to be held on November 7 19 95
I
N A M E RESIDENCE (Add School District, if needed)
DATE SIGNED
(Signature) STREET AND NUMBER, IF ANY CITY
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