Free appnompr.p65 - Wyoming

Precinct Committeemen and Precinct Committeewomen Application for Election by Party Primary
State of Wyoming ) ) ss. W.S. 22-5-204 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 _______________________, state of Wyoming, and that I am registered as a member of the _______________________ party, and I hereby request that my name be printed upon the official party ballot at the next primary 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.

_________________________________ 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 or Town, Zip Code ____________________________________ Telephone Number ____________________________________ E-mail Address ____________________________________ 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 County Clerk None (W.S. 22-5-208 (c))

This form can be accessed on the Secretary of State's WEBSITE at:

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

Qualifications for Office
* *
03/2009 appnompr

Qualified electors of the party residing within the precinct. (W.S. 22-4-101(b)) Precinct committeemen and committeewomen elected at the primary are not required to file a Statement of Receipts and Expenditures.
For office use only: Candidate Packet _______