2010 - Affidfavit of Candidacy - City Council

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Office of the Minnesota - = Secretary of State . y+'~M,. 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. 1m s 2oae o3~. Ylease rint or e. Name (as it will appear on the ballot): ~t~it.W~ yN u rn ~ G.-t. w1. ~G 'C-+ Office Sought: l: i ~..~, ~ ~ u..K ~.,~, C District #: For Partisan Office Provide Political Party or Principle: For Judicial Office Provide Name of Incumbent: Note: All address and contact information is optional fol- 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 Address: 'W\, f OL ~CS Q -~..~~ City: ~.~ ; ~ State: `7M ~ Zip: ~'S / ~ 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): ((~ $~) ) (t ~' s Z ` ~ 3 Campaign Contact Address (Required for those who have checked the box above) Street Address: City: State: Zip: Website: Email: '~'Ctw~ ~, e. ¢. Gle..t~ ~ i n p For all offices. I swear (or affirml that this is my true name or the name by which I am ¢enerally nown 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; • [will have maintained residence in this district for at least 30 days before the general election; and • [f a in~ljor 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 afrer 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: • Con my 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. ~~Gµc v~•.-.ItJ Candidate Signature !o ~ 1 ~ ~ n Date Subscribed and sworn before me this J ay of Sta. ri {. ~ iETH.01~8t~OLL ~ ~~~ Notary public o her officer empowered to „'~ take and certify acknowledgments. Rev. S-10 white copy -Filing Officer yellow copy - CFPD Board goldenrod copy -Candidate pink copy -Public Information