2010 - Affidfavit of Candidacy - City Council

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c~.H.°E.... ~~~ ~~ ~ ~ ` ~~•~~~~ Office of the Minnesota ~• = Secretary of State Filing # Cash/Check # Amount $ 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 fMS zoas.oa~. YICaSt' pl'lrii Ol' Name (as it will appear on the ballot),: O /'l ~ K y5 l/(cf L ~ Yl~l Office Sought: ~!?rili! ~~ '/ District #: K /t For Partisan Office Provide Political Party or Principle: For Judicial Office Provide Name of Incumbent: Note: All address and contact information is optional for judicial, county attorney and county sheriff office candidates. Candidate Residence Address (Do not complete if residence address is to be private and checkbox below is marked) Street Add City:_ (ACS, Psi r ~/t° State:~Zip: '~s/~~ 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 safe~ty^, and I have a/ttach~e/d a separate/form listing my residence address. Candidate Phone Number (Required): (tp ~/) '7 ~/' " ~ ~ tf y Campaign Contact Address (Required for those who have checked the box above) Street Address: City:_ Website: Email State: Zip: 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 ina~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. 1 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. ?'andidate Signatur/e i ~/ ~ ~ Date Subscribed and sworn before me this day of ~~Lt.-K ~ .~ 1:,~ (i ., ~rKONeoo« ~ ~, 1h~ Notary public or er officer empowered to „-~ take and certify acknowledgments. Rev 5-10 white copy -Filing Officer yellow copy - CFPD Board goldenrod copy -Candidate pink copy -Public Information