Free mincanco.p65 - Wyoming

County Offices and District Attorney Minor Party Candidate Information Form
Before filing this application: Please see reverse side for "Qualifications for Office."

State of Wyoming

) ) ss. County of _______________ ) I, _____________________________________, swear or affirm that I was born on______________, that I have been a resident of the State of Wyoming since _______________________, and that I am a registered voter of Election District No. _______________________, in Precinct No._____________________, residing at______________________________________________________________________________, in the County of_________________________________________, (if for the office of state senator or representative) in HD______________ or SD______________, state of Wyoming, and registered as a member of the __________________________________ party, and I hereby request that my name be printed upon the official ballot at the next general election as a candidate for the office of________________________, and hereby declare that if elected, I will qualify for the office. DATED this _______________day of ______________________, 2010.

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Print or type your name exactly as you wish it to appear on the ballot. (W.S. 22-6-111 states that professional titles and degrees shall not appear on the ballot.)

____________________________________ Signature ____________________________________ Residence Address ____________________________________ Mailing Address (if different)

Gender: Male

Female

_______________________________________
In order to meet federal requirements for audio ballots and to accommodate individuals with disabilities, please print your name phonetically on the line above. (i.e., Peggy Nighswonger would be Peg-gee Nice-wong-ger)

____________________________________ City or Town, Zip Code ____________________________________ Telephone Number ____________________________________ E-mail & Website Address

Filing Dates Filing Office

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No later than August 16, 2010 Candidates for federal, statewide and state legislative offices file with the Secretary of State. Candidates for county offices, including district attorneys, file with the County Clerk.

Filing Fee

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$25 - Candidates for state legislative, district attorney and county offices.
This form can be accessed on the Secretary of State's WEBSITE at:

http://soswy.state.wy.us/Forms/FormsFiling.aspx
3/2009 mincanco For office use only: Candidate Packet _______