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HomeMy WebLinkAboutA010 - Receipt of Nomination Papers - Jami Larson F _ff State of Iowa Receipt of Nomination Papers Receipt Number: — r2 Office Received In: ('��f �ex`k Received By: C,,�5 Delivered By: Lc rs ovi Date and Time Delivered: (? / 15 / L:C)c a.m. p.m. Candidate's Name: c�IfYI l I� Office Sought: "6 S Cd 4cyancll , Wa-ydOffice District (if any): Election Type and Date: ❑ General on / / ❑ Primary on / / City on ❑ School on / / ❑ Special on Documents Received: (check all that apply) 9 Affidavit of Candidacy Faxed? ❑ Yes No Nomination Petition Number of pages (approx): _ C4a � ❑ Certificate of Nomination by Convention for Non-Party Political Organization ❑ Certificate of Nomination by Convention for Political Parties Person to contact if there are questions about this filing: n Name: �I ���V��� Phone: Nomination papers are available for public inspection. Objections to the qualifications of candidates and the legal sufficiency of nomination papers may be filed until: ©G /_a-/Wt i This receipt acknowledges the date and time the nomination papers were received. It does not necessarily mean the papers will be accepted for filing. Nomination papers will be carefully checked to be sure they meet basic requirements. The papers will be returned to the candidate if they are rejected. Give original to the candidate and keep a copy for the office. Prepared by the Iowa Secretary of State's Office Revised 7109 L LE L15 2011State of Iowa X) PM Affidavit of Candidacy CITY CLERK 'TA w� 1 LAB C@PP t##er,s.W 14e (exactl it should appear on the ballot): � �1-4 1/ Ir Candidate's Name Sounds Like (phonetic spelling): Type and Date of Election: ❑ Primary on / / ❑ General on / / X City on I / �6 ❑ School on / / ❑ Special on Office Sought: C 1'F_`f'K CiGLLN ; i District or Ward (if any): Vacancy— Is the candidate running to fill a vacancy due to the death, resignation, ❑ Yes No removal, or temporary appointment of an office holder? Candidate's Affiliation (only complete for partisan offices or Ch.44 city nominations): ❑ Democratic ❑ Republican ❑ Not affiliated with any organization ("Nominated by Petition"will be listed with the candidate's name on the ballot.) ❑ Name of Non-Party Political Organization: No more than 5 words and exactly as it should appear on the ballot. Candidate's Home Address: ��-mot � ►��,�r�� � ,n,�� =� ��u✓� ���E �- r �d�.:� Street(no P.O.boxes) City State Zip County Candidate's Mailing Address (if different than above): 1�iAm e ' Street City State Zip County Candidate's Phone:_ cl,.3 Email: \I a �ES�i2 I `� C cn o - c4Kn Candidate's Affirmation I swear(or affirm)that the information provided on this form is correct. l will be qualified to hold this office and if I am elected, I will qualify by taking the oath of office. 1 know that I cannot hold public office if l have been convicted of a felony or other infamous crime and my rights have not been restored by the governor or by the president of the United States. I know that 1 am required to organize a candidate's committee, which shall file an organization statement and disclosure reports if I(or my committee)receive contributions, make expenditures, or incur indebtedness in excess of$750 in a calendar year for the purpose of supporting my candidacy for public office. (This does not apply to candidates for federal office.) l know that l cannot be a candidate forIsetion one office to be filled at this election(except in the case of county agricultural extension council or soil and water co district co Mission). i Candidate's Signature: Must b sig ed in t e presence of a notary. State of: i q County of: (Seal) Signed and sworn(or affirmed)before me on date of: L EMILYA.BURTONieComm =Number742780 By: AMI L �" M res Print C didat ame y �/ / Notary Signa re: rescribed by the Office of the Iowa Secretary of State Revised 412011 State of Iowa Nomination Petition for Non-Partisan Office Candidate Information Name of Candidate: JA N l i LA io--5®& Office Sought: CITY Candidate's County of Residence: "ram �_ Candidate's City of Residence: Type and Date of Election: General on 1 1 []Special on / I Q School on ! / City on Is the candidate running to fill a vacancy due to the death,resignation,removal,or temporary appointment of an office holder? No ❑ Yes (�For Sciroo/FJeclions On tr School District: Sci�ol Director District('rf arry)_ FFor City Ekcdons Only For other Erecdons Only office Ward(if any): > Office District(if any): We,the undersigned eligible electors of the appropriate county,city,school district school or community college director district,or other district as established by law,and the state of Iowa hereby make the nomination outlined above. If the candidate named above accepts the nomination, we believe the candidate is or will be a resident of the appropriate county,city,school district school or community college director district,or other district established by law as required by law. Address where you live in Iowa Sign your name Today's House number and street City Date 2. 3. 6. Z A-n s -- s. r o r 12. w R /� 13.\ , h (Ci 3 s 19e re"S oi,1, ATY-V S 14.` 15. q � � St Vie{ SV�aA rJ LE 5 2011 Prescribed by the Iowa semtary of stabs CITY CL'tizK G� CITY OF LMES,10WA State of Iowa Nomination Petition for Non-Partisan Office Candidate Information Name of Candidate: A P'I i LA K` & Office Sought: C i T Y L404-1 Candidate's County of Residence: 2"�ty � Candidate's City of Residence: A Type and Date of Election: General on ! 1 Special on I f School on I I City on j 1'9 1 YN Is the candidate running to fill a vacancy due to the death resignation,removal,or temporary appointment of an office holder?)&No ❑ Yes chool Elections [�;District School Director District(f any): For Cary Elections Only— For ocher aections only Folfice Ward('d any): F Office District(if any): -� We,the undersigned eligible electors of the appropriate county,city,school district school or community college director district,or other district as established by law,and the state of Iowa hereby make the nomination outlined above. if the candidate named above accepts the nomination, we believe the candidate is or will be a resident of the appropriate county,city,school district,school or community college director district,or other district established by law as required by law. Address where you live in Iowa Sign your name House number and street City T 'S Date 2. -��' �:��1 �20��e�eu 3. 4. 1005a 5. 'sr t. Piz, 6' u zIZ r et"et A ram! /4.,LA 7 /2 2.= (13 -?Icl> cEsc.- � ��'►"^Q T `� /S- (/ /�}2� Rr � �i?� �s 9•Is•/ 15. -�� Igoq 3�t/�:rG,r A4,%es 9_�t5 l r! EEP 1 5 2l01 1 t Prescribed by the Iowa Secretary of state q%a_~1 \ CITY CLERK 5 CITY OF NMIFS.IOVIA State of Iowa Nomination Petition for Non-Partisan Office Candidate Information Name of Candidate: Office Sought C IT Y C-04i Ill<;i I- — 'Z N 0 WA r,> Candidate's County of Residence: !�P-rg> Candidate's City of Residence: A mp— Type and Date of Election: I]General on 1 1 0 Special on 1 1 Ej School on 1 1 City on 11 Is the candidate running to fill a vacancy due to the death,resignation,removal,or temporary appointment of an office holder?)&No Yes Fsz schow Electionsl District School Director District(if any): Fo For City Erections Onty Far Otirer Elections Only ffice Ward(if any): Office District(if any): We,the undersigned eligible electors of the appropriate county,city,school district school or community college director district,or other district as established by law,and the state of Iowa hereby make the nomination outlined above. If the candidate named above accepts the nomination, we believe the candidate is or will be a resident of the appropriate county,dl yK school district school or community college director district or other district established by law as requked by law. Address where you live in Iowa Sign your name Today's House number and street City Date YaCj (, 4' �✓ 3/� �G� 1 y l S 9 � It s �� MAs. 10. .3T 6 � Cf t Z AA [ CUC1C 2 ieory „vim 13. A 14. C AI t- f VI 15. ),56�6 QU\\br a, _ _�... _ SEP 1 5 2011 Pr `4' �Gescribed by the tt„ra Secretary of State � PM U-Y�CI.EI�K CITY[iF NVIFS.InWA �5 State of Iowa Nomination Petition for Non-Partisan Office Candidate Information Name of Candidate: � A L'I i LA K:!5 Office Sought L•IT Y .0-L1 M<:i L. Z 74 T7 f Candidate's County of Residence: --'7-t-,o Candidate's City of Residence: Type and Date of Election: General on I I n Special on / ! ❑School on ! ! 0 City on i'g 1 ) L Is the candidate running to fill a vacancy due to the death,resignation,removal,or temporary appointment of an office holder? No Yes For School Elections On r School District School Director District(if any): (�o For City Elections only For ad"Elections only I office Ward(if any): !1 I F Office District(if any): We,the undersigned eligible electors of the appropriate county,city,school district,school or community college director district,or other district as established by law,and the state of Iowa hereby make the nomination outlined above. If the candidate named above accepts the nomination, we believe the candidate is or will be a resident of the appropriate county,cil)4 school district,school or community college director district,or other district established by law as required by law. Address where you live in Iowa Sign your na � Today's House number and street City Date �w 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. L SEP 1 5 %'111 Prescribed by the Iowa Secretary of State % ' U V CITY CLERK CITY OF A'i,,,!ES,IC`.NA