Reynolds, Pam - Mayor FORM(REVISED 1980)MILLER-DAVIS CO.,ST.PAUL,MN
AFFIDAVIT OF CANDIDATE & RECEIPT FOR FILING
State of Minnesota
TOWN OR CITY ELECTIONS
^ No.
At-)
- / -
County of At Jo�Gc, ss.
I,
(Print name as wanted 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 �" ewo Y
I reside in the City or Township of
My post otUs vddreks is
C— 41y�
(ZiP)
(Sig me as wanted on ballot)
EN
Sub swopE�$'le r � ',,/day of Qj14- ,
to-TAM
Clerk—Notary Public
County,Minn.