DECLARATION OF INTENT Magistrate of the Circuit Court
State of Wyoming ) ) ss. W.S. 5-9-201 through 214 County of ________________)
I___________________________________, swear or affirm that I have been a resident of the State of Wyoming since __________, and that I am a registered voter of _______________County, residing at __________________________________________________ and that I am eligible to be retained to such office, as Magistrate of the __________________ Circuit, _________ judicial district, for a succeeding 4 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.)
_________________________________ Residence Address _________________________________ Mailing Address (if different) _________________________________ City/Town, Zip Code
Gender: Male
Female
____________________________________ Telephone Number _______________________________________
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)
____________________________________ E-mail Address ____________________________________ Website Address
Filing Dates Filing Office Filing Fee
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May 13 through May 28, 2010 County Clerk None
This form can be accessed on the Secretary of State's WEBSITE at:
http://soswy.state.wy.us/election/forms.htm
Qualifications for Office
* Qualified elector and a resident of the county for which appointed. (W.S. 5-9-201)
For office use only: Candidate Packet _______
05/2009 appnommag