Free dec-int.indd - Wyoming

DECLARATION OF INTENT
Supreme Court Justices, District Court Judges and Circuit Court Judges Wyoming Constitution, Art. 5, Sec. 4 (h) I, judicial office as (Supreme Court Justice , the undersigned, hereby declare that I desire to retain my District Court Judge or Circuit Court Judge )

of the ___________ judicial district, for a succeeding _____ year term, or the unexpired term. DATED this day of , 2010.

Signature
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.)

Business Mailing Address City/Town, Zip Code County Business Telephone Number E-mail Address Website Address

Gender:

Male

Female

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

Filing Dates: ....................................................May 3 through August 2, 2010 Filing Offices: ..................................................Secretary of State's Office Elections Office 200 West 24th Street Cheyenne, WY 82002-0020 Filing Fee: ........................................................ None This form can be accessed on the Secretary of State's WEBSITE at: http://soswy.state.wy.us/Forms/FormsFiling.aspx p y y g p
4/2009 dec-int