HomeMy WebLinkAbout2026-07-22Filing # 15 Fee Amount $ "
payment method:
Card I Petition I Check #
/ CV ie ed ID or proof of residence
eviewed affidavit for completeness
Email non-government
Phone number 1 S Z 2. LI- 7536
V. ALE NG eilim # cvmco)f. Art
CITY, TOWN, SCHOOL DISTRICT, & SPECIAL DISTRICT
Affidavit of Candidacy
Information on this affidavit is public data unless noted as private.
See the reverse side for more filing information.
Candidate Information
Candidate name as it will appear on the ballot ASG m 14 P cc N a /LH
Clearly write or type in mixed upper- and lower-case I Include punctuation and accents I No professional titles
Candidate name pronunciation sounds like
If left blank, the accessible ballot marking device's default pronunciation of your name will be used
Office sought CI' Li D tiN E. IL District /Seat number if applicable
Contact Information
Check box if you do not have email
If you check both this box and the private box below,
you must provide an address in Campaign Contact
Residence Address
REMAIN PRIVATE Both boxes must be checked NOT PRIVATE Must provide if boxes to the left are not checked
Residence street address
O I request that my residence address be classified as private data. Seo l rgifIc11 Aye-
O I have completed the Address of Residence Form on the next page.
City eTh /./ A
State (N Zip code S- 5 (/3L
Campaign Contact
Campaign address Optional unless private boxes checked and no email provided
City State
Campaign website Optional P‘50 iv 41 b • coo
Zip code
can be updated with filing officer any time
Affirmation & Signature I swear (or affirm):
• This is my true name or the name by which I am generally known in the community.
• 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 (unless authorized by Minn. Stat. 204B.06, subd. 9).
• I am, or will be on assuming office, 21 years of age or more.
• I will have maintained residence in this district for at least 30 days before the general election.
• I have provided valid identification or documentation of proof of residence authorized in Minn. Stat. 204B.06, subd. lb that matches
the residence address information provided on this affidavit or on a separate form, if address is classified as private data.
• I have provided my phonetic name pronunciation above or I certify that I am directing the official responsible for programming materials
for the election to use the applicable technology's default pronunciation of my name.
• If filing for School Board Member: I also swear (or affirm) I have not been convicted of an offense for which registration is required under
Minn, Stat. 243.166.
• I meet any other qualifications for this office prescribed by law.
COrk Candidate signature
empowered to take and certify acknowledgment
Signature of notary public or other officer Weimar
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Subscribed and sworn to before me this day of , 20 9.4,