2010 - Affidfavit of Candidacy - City Council

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~y.:~~;~:~"~~...•.:~ Office of the Minnesota Filing# Cash/Check # Secretary of State Amount$ .,L~jg~g%. 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. (mts zoaa.o3~. Please rint or e. Name (as it will appear on the ballot): 1"'1 i c..~nQ~ r vt M i ek ~' ~~- ~}pvt Office Sought: Ct~ ~ For Partisan Office Provide itical Party or Princ 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 A~'/ddress (Do not complete if residence address is to be private and checkbox below is marked) Street Address:- ~ ~tOZ C.~-U ~~ ~ C ~ W ~~ CitY:_ SP~II~ip State: r~ Zi ~~(~ -~-- p~ 3 D 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): ( ~D iZ ) 3(p - ~g?) Carnl~aign Contact Address (Required for those who have checked the box above) Street Address: city:- Website State: Zip; Email: WI i C. ~O)( (b ~ tA1SVl Gc> vtn For all offices, I swear (or affirm) that this is my true name or the name by which I am generally known in the community. If filing for a state or local office, I also swear (or affirm) that: • 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 in:t,jor political party candidate, 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 Member - I have not been convicted of an offense for which registration is required under Minnesota Statutes, section 243.166. • County, Municipal, School District, or Special District Office - I meet any other qualifications for that office prescribed by law. ~~ Subscribed ands om before me this _~ day of ~t.~.n t oZ/6? J , O6 i o ~ i ~~a ~AFitiARETFi. DF~900LL ~( 1 Date ~y Pt~O'~1NOr otary publi r other officer empowered to ~ .Atnal.llOfa ake and certify acknowledgments. white copy -Filing Officer yellow copy - CFPD Board oldenrod co Rev. 5-ul g py -Candidate pink copy -public Information