Declaration of Candidacy & Treasurer - Shoushtarian, Al - 9/1/2011DECLARATION 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
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11�0 III' YNotary Public for the State of Idaho
STATE T' 0IDAHO Residing at:
My Commission Expires: —c1
OFFICIAL USE ONLY
CITY CLERK
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 t
This declaration was accepted
on
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q-1— / / 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 nd time of receipt on the front of
this document. This document is to be used for ballot preparation.
K:\Clerks\ELECTION\General Election 2011\Declaration of Candidacy\Declaration of Candidacy - City Council.doc
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APPOINTMENT AND CERTIFICATION OF POLITICAL TREASURER Rev. o of
N o FOR CANDIDATES AND COMMITTEES
(Please Print or Type)
0
r 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):
Name of
CANDIDATE: Candidate:
Name of
❑ COMMITTEE: Committee: SEP 0 1 2011
Name of Committee Pll :
Chairman: out to:
Miscellaneous: ❑ Home Work Cell
Phone: Phone: Phone:
Measure: ❑ Committee
Candidate/Measure: ❑ Mailing address:
Chairman
email address:
CERTIFICATION AND APPOINTMENT
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:
Name of t
Political Treasurer: J()dUT)Mil ZD 1
Home �l C—�--(� (� Work Cell
Phone: to Phone: Phone:
Treasu
er
Mailing address:
Treasurer
U� 7
RETURN THIS
FORM TO:
Sharon Bergmann
City Clerk
City of Eagle
PO Box 1520
Eagle, ID 83616
(208) 939-6813
Fax: (208) 939-6827
email address:.. �._, .(
Signature of Candidate or Committee Chairman
I, C_r X0,L ,5h � I sndo hereby accept the appointment as political treasurer for
Name o Political Treasurer
the above named candidate or committee.
Signature of Political Treasurer
Home 3L3(0WorkCell
Phone:
Phone: I /
SF
Phone: Ckli,.
_
_
Office (
Sought:
Seat (if
applicable)
Candidate
ffi
Mailing
f
address:
Candidate
email address:
FC I IL
ITY OF EAGLE01
Name of
❑ COMMITTEE: Committee: SEP 0 1 2011
Name of Committee Pll :
Chairman: out to:
Miscellaneous: ❑ Home Work Cell
Phone: Phone: Phone:
Measure: ❑ Committee
Candidate/Measure: ❑ Mailing address:
Chairman
email address:
CERTIFICATION AND APPOINTMENT
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:
Name of t
Political Treasurer: J()dUT)Mil ZD 1
Home �l C—�--(� (� Work Cell
Phone: to Phone: Phone:
Treasu
er
Mailing address:
Treasurer
U� 7
RETURN THIS
FORM TO:
Sharon Bergmann
City Clerk
City of Eagle
PO Box 1520
Eagle, ID 83616
(208) 939-6813
Fax: (208) 939-6827
email address:.. �._, .(
Signature of Candidate or Committee Chairman
I, C_r X0,L ,5h � I sndo hereby accept the appointment as political treasurer for
Name o Political Treasurer
the above named candidate or committee.
Signature of Political Treasurer