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Home My WebLink AboutA006 - Receipt of Nomination Papers - Anita Rollins, Ward 3 State of Iowa Receipt of Nomination Papers Receipt Number: 2C 2-1 _ Office Received In: CAN c.-kE 1 Received By: Delivered By: V15 Date and Time Delivered- p.m. Candidate's Name: Office Sought: �'��-`- Office District(if any): Election Type and Date: ❑ General on / ! ❑ Primary on / / 2�City on 1�_/ Cq/ 2-CZ_ ❑ School on / / ❑ Special on / / Documents Received: (check all that apply) Affidavit of Candidacy Faxed? ❑ Yes �No Nomination Petition Number of pages (approx): ,3 ❑ 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: .-IGi'ic��'iC'SS Ca �—y' C�ev-� Phone: Nomination papers are available for public Inspection. Object'ons to the qualifications of candidates and the legal sufficiency of nomination papers may be filed until: / I /aCai 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 State of Iowa Affidavit of Candidacy AUG 2 4 2021 Candidate's Name(exactly as it should appear on the ballot—no titles,parentheses,or quotation mar s).. 1 Anita Rollins CITY CLERK Candidate's Name Sounds Like (phonetic spelling):Aneeta Rawlins g �. M ° 3 Office Sought: City Council >� � District or Ward (if any): Vacancy—Is the candidate running to fill a vacancy due to the death, resignation, FE-] No ❑ Yes removal,or temporary appointment of an office holder? Type and Date of Election: ❑ Primary on / / ❑ General on City/School on 11 /02 /21 ❑ Special on Candidate's Affiliation (only complete for partisan offices or Ch.44 city nominations): ❑ Democratic ❑ Republican Not affiliated with any organization ❑ Name of Non-Party Political Organization: No more than 5 words and exactly as it should appear on the ballot. Candidate's Home Address: 3714 Woodland St. Ames IA 50014 Story Street(no P.O.boxes) City State Zip County Candidate's Mailing Address (if different than above): Street City State Zip County Candidate's Phone:515-451-8032 Email:anitarollins@gmail.com Candidate's Affirmation I swear(or affirm) that the information provided on this form is correct. I will be qualified to hold this office and if 1 am elected, 1 will qualify by taking the oath of office. I know that I cannot hold public office if 1 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. 1 know that/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$1,000 in a calendar year for the purpose of supporting my candidacy for public office. (This does not apply to candidates for federal office.) I know that I cannot be a candidate for more than one office to be filled at this election, except as otherwise provided by law. Candidate's Signature: Must be signed in t h presence of a notary. State of: , County of: IUn � A ANGEL TEJEDA ' C04N NUMBER 812861 Signed and sworn(or affirmed)before me on date of: MY PQMMISSION EXPIRES By: t�� 1 t��1 �� ✓;`7 1 Print Candidate's Name Notary Signature: ��` �' (n� (/� Notary Public or authorized notary under§9B.10 T s Prescribed by the Office of the Iowa Secretary of State Revised 1012019 State of Iowa Nomination Petition for Non-Partisan Office Candidate Information Name of Candidate: Anita Rollins Office Sought: City/ Council Candidate's County of Residence: Story Candidate's City of Residence: Antes Type and Date of Election: ❑General on / / Special on / / �. City/School on 11 102 /2021 Is the candidate running to fill a vacancy due to the death,resignation,removal,or temporary appointment of an office holder.? Q■ No Yes F For School Elections Only school District: School Director District(if any): 1 I For City Elections Only For Other Elections Only FOffice Ward(if any): 3 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. �-3.5 J 3. 4. f 7 dL l Er.rl` I ► -�1 e C'� b4�e.S 7 -3 z► 5. _ - v s. 7 3! -ZI 7. !Z 7 - 31 -z_I 8. l O_ - 1 10. 11. ..._.._ 1 142 i- 13. 15. AUG 2 4 2021 Prescribed by the Iowa Secretary of State CI jWW2021 CITY OF AMES 10t^!A State of Iowa Nomination Petition for Non-Partisan Office Candidate Information Name of Candidate: Anita Rollins Office Sought: City Council Candidate's County of Residence: Story Candidate's City of Residence: Ames Type and Date of Election: M General on / / Special on City/School on 11 102 12021 Is the candidate running to fill a vacancy due to the death,resignation,removal,or temporary appointment of an office holder? ® No Yes F For School Elections Only chool District: School Director District(if any): 7For City Elections Only r For Other Elections Only 0ffice Ward(if any): 3 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 2. � . 4 C 3 C 3 Dr ►tee 5 -2z -2/ 5. wnc 4J c c, 16, 6. Z Uv" , D 7. � 1 1c� 8. " 0)'7 a,r s- ram— 7 . /� r 10. cv'_ 13. � 14. _ f "V C� � 15. I } 1 AUG 24 2021 Prescribed by the Iowa Secretary of State CITY OF AMES, IOWA State of Iowa Nomination Petition for Non-Partisan Office Candidate Information Name of Candidate: Anita Rollins Office Sought: City Council Candidate's County of Residence: Story Candidate's City of Residence: Ames Type and Date of Election: General on / / ❑Special on / / .�City/School on 11 /02 12021 Is the candidate running to fill a vacancy due to the death,resignation, removal,or temporary appointment of an office holder? ® No Yes F For School Elections Only chool District: School Director District(if any): F For City Elections Only For Other Elections Only office Ward(if any): 3 Office District(if any): We,the undersigned eligible electors of the appropriee 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 nominatinn 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 taw. Address where you live in Iowa Sign your name Today's House number and street City Date 2. ;T 4-- �w van 1 . -3 4 ' 6. 2 8. 9 9. ,ZEo 03CA7- I QV,;-W0 Nlc 5 s /vim •2a ° �ti VI.At'd St. r� 1 6 17 `� g 4z kk_., 3z�:�- iDLLej 15. o a. M AUG 2 4 2021 . Prescribed by the Iowa Secretary of State Revised 412021 CITY CLERK i