Lund, Scott - Mayor FORM(REVISED 1980)MILLER-DAVIS CO.,ST.PAUL,MN
AFFIDAVIT OF CANDIDATE & RECEIPT FOR FILING
TOWN OR CITY ELECTIONS
State of Minnesota No. —
�cd
County ofd
(Print name as wanted A ballot)
swear (or affirm) that I am qualified under the Constitution and Laws of the United States and State of Minne-
sota to seek the elective public office indicated below. I am a qualified voter in the subdivision where I seek
election. I will be 21 years of age or more on assuming office. I will be a resident of my election district for at
least 30 days by election day. I have not filed for any other office at this election.
I am seeking election to the office of `/ /)wff
I reside in the City or Township of F
My post office address is SY0" TA Ate- Aek
ss Y3 L (Zip)
(Sign na as Avnted on ballot)
-SubscribeAand swore to before me this ` day QD
W , ( )Cl Notary Public
�SFAL d County,Minn.
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