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<br />POLITICAL CANVASSING <br /> <br />. <br /> <br />1.0 is the <br />name. My office is located at <br />and my teiephone number is <br /> <br />for the Insert orQanizations <br /> <br />2.0 Between the _ day of , 2005 and the _ day of <br />, 2005, the individuals identified on the attached spreadsheet <br />("Canvassers") will be contacting residents within the City of Arden Hills on behalf <br />of the insert orQanizations name, and will be involved in the following activities: <br /> <br />3.0 All of the Canvassers have current photo identifications or photo driver's licenses, <br />and copies of such identification are attached to the spreadsheet. <br /> <br />4.0 None of the Canvassers have been convicted of a crime other than traffic <br />violations, except those whose names are marked with an "*" on the spreadsheet. <br />As to those individuals, I have attached an exhibit which identifies the nature of <br />the crime, the punishment and the penalty assessed. <br /> <br />5.0 On behalf of myself and the insert orQanizations name, I attest to the accuracy <br />of the information provided herewith. <br /> <br />. <br /> <br />Dated: <br /> <br />,2005 <br /> <br />Name: <br /> <br />STATE OF MINNESOTA ) <br />)SS <br />COUNTY OF ) <br /> <br />The foregoing instrument was executed by on the _ day of <br />, 2005, who executed the same by his/her own free hand and will. <br /> <br />Notary Public <br /> <br />F:\users\Janice\Jerry\Arden Hills\Grassroots Voter Outreach Political Canvassing. doc <br /> <br />. <br />