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~~..n.E.... <br />~` ~~~~~~~ Office of the Minnesota Filing# <br />Cash/Check # <br />~~ = Secretary of State Amount $ _ <br />Affidavit of Candidacy <br />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. <br />Note: If filing for partisan office and not a major party candidate, you must file both an affidavit of candidacy and a nominating petition cros zoas.osl. <br />rlease Dr~nt or <br />Name (as it will appear on the ballot): ~.~~ V ~/~ 'T'C. TS <br />Office Sought: L~ 1h~, L~n[_,1 w1'Rst~e!' District#: ~2~~Q <br />For Pt1rllSan Office Provide Political Parry or Principle: <br />For Judicial Office Provide Name of Incumbent: <br />Note: All address and contact information is optional for judicial, county attorney and county sheriff office candidates. <br />Candidate Residence Address (Do not complete if residence address is to be private and checkbox below is marked) <br />Street Address: ~~ (j ~ ~~ ~~ t2c,~ ~ , Nt <br />City: ap~y".\~ Stater Zip: 5~ ~) ~ <br />^ 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 <br />regarding my safety or my family's safety, and I have attached a sheparaete form listing my residence address. <br />Candidate Phone Number (Required): (~75~ ) ~~ -~ lb 1 <br />Campaign Contact Address (Required for those who have checked the box above) <br />Street Address: <br />City <br />Website: <br />State: Zip: <br />Em a i I: CX~~B~~121`5 Q ~u 4-»~, C~y+~ <br />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. <br />If filing for a state or local office, I also swear (or affirm) that: <br />• I am eligible to vote in Minnesota; <br />• I have not filed for the same or any other office at the upcoming primary or general election; <br />• I am, or will be on assuming office, 21 years of age or more; <br />• I will have maintained residence in this district for at least 30 days before the general election; and <br />• [f a irutjor 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 <br />candidates at the next general election. <br />If filing for one of the following offices, I also swear (or affirm) that I meet the requirements listed below: <br />• 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 <br />less than nine years on the next January 3rd, or if filled at special election, within 21 days after the election. <br />• 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 <br />for not less than seven years on the next January 3rd, or if filled at special election, within 21 days after the election. <br />• 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 <br />than one year on election day. I am filing jointly with <br />• Supreme Court Justice, Court of Appeals Judge, District Court Judge, or County Attorney - I am learned in the law and licensed to practice <br />law in Minnesota. My Minnesota attorney license number is and a copy of my license is attached. <br />• State Senator or State Representative - I will be a resident of Minnesota not less than one year and of [his district for six months on the day of the <br />general or special election. <br />• County Sheriff - 1 am a licensed peace officer in Minnesota. My Board of Peace Officer Standards and Training license number is <br />and a copy of my license is attached. <br />• School Board Member - I have not been convicted of an offense for which registration is required under Minnesota Statutes, section 243.166. <br />• County, Municipal, School District, or Special District Office - I meet any other qualifications for that office prescribed by law. <br />and sworn before me this <br />of ~ia.f~o . oZ) <br />~andidate Signature -- --"--"-"----"------------- <br />~H <br />(~ / ~ / Z~ ID NOIaryPUbrO•MYM1M01~ Not <br />Date >i~H to a an <br />white copy -Filing Officer yellow copy - CFPD Board goldenrod copy -Candidate <br />or <br />D. <br />~~ <br />d to <br />pink copy -Public Information <br />Rev. S-10 <br />