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Home My WebLink AboutA009 - Receipt of Nomination Papers - Brad Heemstra I r State of Iowa Receipt of Nomination Papers Receipt Number: Ij 1 0Z Office Received In: IhA � Received By: qftO Delivered By: eC Date and Time Delivered: 15 /IL_ L: a.m /p.m. Candidate's Name: 'j1( Office Sought: t i Ja[ Office District (if any): Election Type and Date: ❑ General on / / ❑ Primary on / / A City on / ! ❑ School on / / ❑ Special on Documents Received: (check all that apply) ® Affidavit of Candidacy Faxed? ❑ Yes No qv� Nomination Petition Number of pages (approx): to ❑ 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: Name: Da,,i Ve uas Phone: g3 Nomination papers are available for public inspection. Objections to the qualifications of candidates and the legal sufficiency of nomination papers may be filed until: 0/ ot7 / d0ll 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 r State of Iowa SEP 15 2011 Affidavit of Candidacy 05 exactly as it hould appear on the ballot): CITY OF AMES,IOWA t a e s Name Sounds Like (phonetic spelling): Type and Date of Election: ❑ Primary on / / General on li / / ❑ City on ❑ School on / / ❑ Special on / / Office Sought: Ito 14 a,( Tv-`y f e-e_ 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: Street(no P.O.boxes) C City State Zip Cou y Candidate's Mailing Address (if different than above): Street City State (` I Zip I Countfy�' Candidate's Phone: 5 (d-233 - Z217 Email: by-cai �z'ectiis �1�"I� w1^' t f qjr� . C_Gj t Candidate's Affirmation 1 swear(or affirm) that the information provided on this form is correct. l will be qualified to hold this office and if 1 am elected, I will qualify by taking the oath of office. I know that 1 cannot hold public office if I 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 I 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.) 1 know that/cannot be a candidate for more than one o ice to be fill t this election(except in the case of county agricultural extension council or soil and water ervation distn commission Candidate's Signature: Must be signed in the presence of a notary. State of: County of: �r (Seal) Signed and sworn (or affirmed)before me on date of: (z4 I i► LC Cwvykslort Number 761592 By: .Y`^ a f '✓`'� .•s"^ MyGo m Isslon Expires Print Candidate's ow Z,(,ZZ�1.3 Notary Signature: LM L'.LAk3� _�,_ .._ __. Prescribed by the Office of the Iowa Secretary of State Revised 412011 Vie I VI 111FI L.J.iVYY/i . State of Iowa Nomination Petition for Non-Partisan Office Candidate Information Name of Candidate: �` Mj Office Sought: &,)SPIL Candidate's County of Residence: Candidate's City of Residence: A&V e Type and Date of Election: dGeneral on /�/� n Special on I i-1 School on / /_ City on II Is the candidate running to fill a vacancy due to the death,resignation,removal,or temporary appointment of an office holder? ["No Yes FFor School Elections Only School District: School Director District(if any): FFor City Elections Only For Other Elections Only Office Ward(if any): I FOffice 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 . � of y,�ct r « ��/' Y cin i 2. r,-Y-- e f s. 2 410 Gt1t^ �•U �' F 4. 31 b �� s^r s S-r es J ySe lI 5. Ave / 6. 7. 8. 9. Z G' 14 _ 10. aVa q-f�-Y 12. 5�,i �v 6e_t-ve,-L� Dy 9 14/2o 11, 13. 8 [ l Fn va 'Dt- Av12e s 14. 15. L rFSE175 2011 Prescribed by the Iowa Secretary of Statej/t]vt CITY CLERK CITY OF F�Pv1ES,IOVJA State of Iowa Nomination Petition for Non-Partisan Office Candidate Information r Name of Candidate: i &f=,Q_A,_sf,(PLOffice Sought: Candidate's County of Residence: 1r Candidate's City of Residence: —.AM 5 Type and Date of Election: General on / /_I L n Special on / /__ n School on / / n City on / I 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 Only School District: School Director District(if any): For City Elections Only For Other Elections 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. 5h� ey 5. - 6. ) Ou _ Z/ L 911,Z111 �2 AZ 9W12- i/ 8. - �-(1') 2-72H Ci aW fcn 9 f 1 S/01 u �s 11 �o ��l lit LbA \NJ r)O�U 12 O 1 1 Keith 13. r 1 Ca Aw', 14. 15. L IE SEP 1 5 2011 Prescribed by the Iowa Secretary of State Q'05,w CITY CLERK CITY OF AYES. IOWA State of Iowa Nomination Petition for Non-Partisan Office Candidate Information Name of Candidate: �BoxJ@ Office Sought: &JSQf � ' T✓5�� Candidate's County of Residence: Candidate's City of Residence: Type and Date of Election: [VrGeneral on /�/� F1 Special on / / n 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? M No Yes FFor School Elections Only School District: School Director District(if any): oFor City Elections Only For Other 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 directordistrict, 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 1 3. 1I �/' z /mil 5. ' 6 LA If/ 7. Aj _�)C I 8. Co IQ 11 9. 3401 e q 20gt'/� 1 c s 9 12. L / �rje�rich 13. J� A :OF E [SEEP5 2011 Prescribed by the Iowa Secretary of State .IES,IOWA State of Iowa Nomination Petition for Non-Partisan Office Candidate Information Name of Candidate: BmJA-eqm4m Office Sought:�- spn� a�T✓S��L t . Candidate's County of Residence: Ir- Candidate's City of Residence: Type and Date of Election: dGeneral on /_I L ❑Special on I I n School on �J / _ / F—]City on—/ / Is the candidate running to fill a vacancy due to the death,resignation,removal,or temporary appointment of an office holder? M No Yes FFor School Elections Only school District: School Director District(if any): FFor City Elections Only (�For Other Elections Only Office Ward(if any): I 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 ZY1l� t�t1 4,47 -tirtiat�avr 4. 230'7 14jelrVsr 40e. A V",e3 g12If If/// fI h �� /lam'9 Qc`✓'c-� l�,rc ate ' Z �htrr�I 6. - MwveA 7 Y f/ Af-e LDW5 / Pj,ani# 9. f- 1 3 &6 1 b S t /,z�/,� wit v �• G O '/( W\y 12. 32oa 13. ah1.CCk �rm�Gi2 14 0 L I SEP 15 2011 Prescribed by the Iowa Secretary of State 9 9;ps,im C11Y CLERK CITY Oi/1IMIrS.IOWA State of Iowa Nomination Petition for Non-Partisan Office Candidate Information Name of Candidate: -'BmJ &eem5fm Office Sought:&DSpi�x f 1 Candidate's County of Residence: d Candidate's City of Residence: s Type and Date of Election: dGeneral on Li_/ 9 / I n Special on l / School on / I I_)City on Is the candidate running to fill a vacancy due to the death,resignation,removal,or temporary appointment of an office holder? [g No Yes Fs For School Elections Only chool District: School Director District(if any): oFor City Elections Only (�For Other Elections Only ffice Ward(if any): I 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 1. 3-7 i C�t,�r�i3tNe �1 tz�t M 5 S -2G- i 2 Chr,s *rhtwa 3. AMG_S `b1 Z(./r� 4. i. wif 2 ,rn - 9-2-7--11 Lj 7 t -5 7 / 2 f� 8. I ,. a c3 �o � F/eT<Her BIOd � rnes $ 27- /! 9. -�o r +C_ u_ Ave,5 z7- 1 0. 31-z I 1 ��► l� r Imb, S g�a7 I Bed111( 13. 14. t 15. ! MCI go U C�6 9 L IE SEP 15 2011 Prescribed by the Iowa Secretary of State 6) 9-05 444 CITY CLERK CITY OF AMES,IOWA