Reynolds, Pam - Write in Request City Clerk's Office
Date Received
Forward to
Copy to
Office of the Fridley City Clerk
WRITTEN REQUEST BY WRITE-IN CANDIDATES FOR CITY OFFICE
Instructions
"City office" includes all city offices up for election in 2016. If you would like to be considered
as a"write-in" candidate, you must submit this form to the City Clerk. This form must be filed
with the City Clerk prior to November 1, 2016 for write-in votes to be counted separately.
Statement
PAM R5Nr, 1OLDS
Who resides at j ( o_t I Ave. r' 1 j 18 vI '55 (ta
Requests that all write`-Cin votes cast for me for the office of M yo 0,4 vir,'I A 12y
At the Minnesota state general election on November 8, 2016 be counted in accordance with
Fridley City Charter Section 4.08.
410
Signature 1
Date - 7_ 6
2016