Free municand.p65 - Wyoming

Municipal Offices Application for Nomination by Primary State of Wyoming County of _____________ ) ) ss. W.S. 22-23-302 )

I,________________________________________, the undersigned, swear or affirm that I was born on _________________, and that I have been a resident of the State of Wyoming since ______________________, and that I am a registered voter of Election District No____________, Precinct No____________, in Ward No. _______________, in the City of ________________________________, and the State of Wyoming, residing at _________________________________________________________________________________ as of the closing of the municipal clerk's office on the day this petition is filed, do hereby petition and request that my name be printed upon the Official Municipal Primary Ballot at the next primary election as a candidate for the office of ______________________________________________________. I hereby declare that if nominated and elected, I will qualify for the office. DATED this __________ day of _____________________________________, 2010.

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

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)

Filing Dates Filing Office Filing Fee

.... ... ...

May 13 through May 28, 2010 City or Town Clerk $25
This form can be accessed on the Secretary of State's WEBSITE at:

http://soswy.state.wy.us/Forms/FormsFiling.aspx

Qualifications for Office
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Are you holding an office or are you a city employee which may conflict or be incompatible with the office you are seeking? Candidates for municipal office must be a registered voter and a resident of the municipality and ward which he seeks to represent. (W.S. 22-23-301)
For office use only: Candidate Packet _______

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03/2009 municand