2010 - Affidavit of Candidacy - Mayor

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6~ Filing # .~~~,~...~.........~ Office of the Minnesota _ r. ' Cash/Check # Secretary of State Amount$_ f1858* Affidavit of Candidacy All information on this form is available to the public. Information provided will appear on the Secretary of State's website at www.sos.state.mn.us. Note: If filing for partisan office and not a major party candidate, you must file both an affidavit of candidacy and a nominating petition. lm.s. zoas.os). Please print or Name (as it will appear on the ballot): ~ ~-~ V Office Sought: MJ4 ~{O R (`~~ For Partisan Office Provide Political Party or Principle: For Judicial Office Provide Name of Incumbent: District #: Note: All address and contact information is optional for judicial, county attorney and county sheriff office candidates. Candidate Residence Address (D~ not complete if residence address is to be private and checkbox below is marked) Street Address: City State: 1" tN Zip: ~~-j~~ ~ 3 ^ My residence address is to be classified as private data. I certify a police report has been submitted, or I have an order for protection regarding my safety or my family's safety, and I have attached a separate form listing my residence address. Candidate Phone Number (Required): ( ~ ) ~~~~ ~~ ~~. Campaign Contact Address (Required for those who have checked the box above) Street Address: City: State: l Zip: Website: Email: ~~4~s~ ~ 11~ ~ C'L~6VI~S1 ` h For all offices, I swear (or affirm) that this is my true name or t e name by which I am generally known in the community. If filing for a state or local office, I also swear (or affirm) th • I am eligible to vote in Minnesota; • I have not filed for the same or any other office at the upcoming primary or general election; • I am, or will be on assuming office, 21 years of age or more; • I will have maintained residence in this district for at least 30 days before the general election; and • [f a major political party candidat; , I either participated in the party's most recent precinct caucuses or intend to vote for a majority of that party's candidates at the next general election. If filing for one of the following offices, I also swear (or affirm) that I meet the requirements listed below: • United States Senator - I will be an inhabitant of this state when elected and I will be at least 30 years old and a citizen of the United States for not less than nine years on the next January 3rd, or if filled at special election, within 21 days after the election. • United States Representative - I will be an inhabitant of this state when elected and I will be at least 25 years old and a citizen of the United States for not less than seven years on the next January 3rd, or if filled at special election, within 21 days after the election. • Governor or Lieutenant Governor - I will be at least 25 years old on the first Monday of the next January and a resident of Minnesota for not less than one year on election day. I am filing jointly with • Supreme Court Justice, Court of Appeals Judge, District Court Judge, or County Attorney - I am learned in the law and licensed to practice law in Minnesota. My Minnesota attorney license number is and a copy of my license is attached. • State Senator or State Representative - I will be a resident of Minnesota not less than one year and of this district for six months on the day of the general or special election. • County Sheriff - I am a licensed peace officer in Minnesota. My Board of Peace Officer Standards and Training license number is and a copy of my license is attached. • School Board Mem ave not been convicted of an offense for which registration is required under Minnesota Statutes, section 243.166. • County, M I, S~I DI rict, or Special District Office - I meet any other qualifications for that office prescribed by law. ~; i ~ ~~ Date Subscribed and sworn before me this day of oZQ 0 ~y11~iA JO MIDERSON o ~l"'` ,' NOir'yA~bNaMbmes018 N aI public or oth fficer et owered to . ~ ~t3 t e ar d certify acknowledgments. white copy -Filing Officer yellow copy - CFPD Board goldenrod copy -Candidate pink copy -Public Information Rev. S-10