Declaration of Candidacy & Treasurer - Reynolds, James D. - 9/8/2011DECLARATION OF CANDIDACY
FOR MAYOR
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 Mayor, 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 ualifications o fill said off ce, and the my residence address is
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Subscribed and sworri to before ihs this day
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"OFFICIAL USE ONLY
CITY CLERK
's Signature
201
Jotary PWlic e ate of
Residing at:
My Commission Expires: _L
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
N e
Title
r
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 documents is to be used for ballot preparation.
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KAClerks\ELECTION\General Election 201 Meclaration of Candidacy\Declaration of Candidacy - M®ayor.doc
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APPOINTMENT AND CERTIFICATION OF POLITICAL TREASURER c-'
FOR CANDIDATES AND COMMITTEES Rev. 08/07
(Please Print or Type)
Pursuant to Section 67-6603(c1), 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):
Candid to ....k. ...
CANDIDATE: James D. Revnolds (,Tim)
COMMITTEE: Comeof
..M.-
Committee: te,m
Name of Committee
Chairman:
Miscellaneous: [—]
Home
Phone:
Measure: El
Committee
Candidate/Measure:
Mailing address:
...._.............
Chairman
email address:
Work C0
Phone: Phoneo
CERTIFICATION AND APPOINTMENT
w
t' OFF'AGL t
-James D . Revnolds , do hereby certify and appoint the following individual who is a registered elector of
Name of Candidate or Committee Chairman
the State of Idaho as the political treasurer for the above named candidate or committee:
RETURN THIS
FORM TO:
Sharon Bergmann
City Clerk
City of Eagle
PO Box 1520
Eagle, ID 83616
(208) 939-6813
Fax: (208) 939-6827
Name of
Political Treasurer: Kathleen Roma
Home Work Cell
Phone: 208-376-1652 Phone: 208-888-1830 Phone. 208-859-0974
Treasurer
Mailing address: 1
VTreasurer
email address:
S. Anco
Kathleen@RomaCPA
150 Eaal
�1 U Signature of CarfdidatAr Committee Chairman
Name of Political Treasurer do hereby accept the appointment as political treasurer for
the above named candidate or committee. vj"c L"')
Signature of Political Treasurer