Declaration of Candidacy & Treasurer - Defayette, Mary - 8/26/2011DECLARATION OF CANDIDACY
FOR CITY COUNCIL
I, the undersigned, affirm that I am a qualified elector of the City of Eagle, State of Idaho, and
that I have resided in the City of Eagle for at least thirty (30) days.
I hereby declare myself to be a candidate for the office of City Council, for a term of four (4)
years, to be voted for at the election to be held on the 8th day of November, 2011, and certify
that I possess the legal qualifications to fill said office, and the my residence address is
iial At -/Mom 11A 0
OFFICIAL USE ONLY
CITY CLERK
Notary Public for the plate of Idaho
Residing at:
My Commission Expires:
Before accepting this Declaration of Candidacy, the City Clerk (or designee) must verify the
following.
This Declaration is accompanied by:
The attached Petition of Candidacy signed by at least five qualified city electors
with the attached verification from the county clerk,
OR
A nonrefundable filing fee of $40.
The City Clerk (or designee) must verify that the person submitting this declaration is a
qualified city elector as defined in Idaho Code 50-402(c) and that the residence address
provided above matches the address on the individual's voter registration.
This declaration was accepted by °W
i`lle
on X - 9- f/ at
Date Time
After the close of the candidate filing period, a copy of this form must be transmitted
immediately to the Ada County Clerk to assist in ballot preparation.
COUNTY CLERK
Upon receipt of this Declaration of Candidacy, stamp the date and time of receipt on the front of
this document. This document is to be used for ballot preparation.
KAClerks\ELECTIOIV\General Election 20I Meclaration of Candidacy\Declaration of Candidacy - City Council.doc
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APPOINTMENT AND CERTIFICATION OF POLITICAL TC-1REASURER
Rev. 08107
FOR CANDIDATES AND COMMITTEES
0
(Please Print or Type)
Pursuant to Section 67-6603(cl), Idaho Code. No contribution shall be received or expenditure made by or on behalf of a
candidate or political committee until he or she appoints a political treasurer and certifies the name and address of the treasurer
to the Secretary of State.
Certification is for (check appropriate box below):
Name of
Z�CANDIDATE: Candidar/nqk�,Peiqefte
Home Work Cell 2OF q(_10 12 --
Phone: Phone: Phone. L
OfficeSeat (if
Sought: faj, J -e CIA11 Coun c I applicable)
Candidate ? L/ o 0 F_ 14 P he,
Mailing address
t_- a
Candidate
ennai! addres,
File:
Route to:
CERTIFICATION AND APPOINTMENT
1, --e- do hereby certify and appoint the following individual who is a registered elector of
11!`a�me of �Candi to or Comm tee hairman
,tn
hair
the State of Idaho as the pDo itical treasurer for the above named candidate or committee:
Name of/n4�1/ De-fa--jefl-C
Political Treasurer. C-111
RETURN THIS
FORM TO:
Sharon Bergmann
City Clerk
City of Eagle
PO Box 1520
Eagle, 18 3616
(208) 939-6813
Fax: (208) 939-6827
Home
Phone
Work
Phone
Treasurer /5- Ht9k
�t
Mailing address:
Treasurer 3491 tp
email address: /-104CV dr-fe efle .1 -00 L,
Cell
Phone:
ZYrf andiclate r
Signat e of andiclate mittee Chairman
i;_A"w_q De-faqa-Lp, —, do hereby accept the appointment as political treasurer for
Ndme of Politic 4.1;dasurer
the above named candidate or committee.
I�Sign�atur f ' t I
Treasurer
Name of
COMMITTEE:
Committee
Name of Conirnittee
Chairman:
Miscellaneous: El
Home Work Cell
Phone. Phone: Phone:
Measure: E-1
committee
Mailing address:
CandiCandidate/Measure:
ElChairman
email address:
File:
Route to:
CERTIFICATION AND APPOINTMENT
1, --e- do hereby certify and appoint the following individual who is a registered elector of
11!`a�me of �Candi to or Comm tee hairman
,tn
hair
the State of Idaho as the pDo itical treasurer for the above named candidate or committee:
Name of/n4�1/ De-fa--jefl-C
Political Treasurer. C-111
RETURN THIS
FORM TO:
Sharon Bergmann
City Clerk
City of Eagle
PO Box 1520
Eagle, 18 3616
(208) 939-6813
Fax: (208) 939-6827
Home
Phone
Work
Phone
Treasurer /5- Ht9k
�t
Mailing address:
Treasurer 3491 tp
email address: /-104CV dr-fe efle .1 -00 L,
Cell
Phone:
ZYrf andiclate r
Signat e of andiclate mittee Chairman
i;_A"w_q De-faqa-Lp, —, do hereby accept the appointment as political treasurer for
Ndme of Politic 4.1;dasurer
the above named candidate or committee.
I�Sign�atur f ' t I
Treasurer