www.somersetwestandtaunton.gov.uk
V.3 Page 6 of 6
Declaration
I can confirm that to the best of my knowledge the information contained in this
nomination form is complete and accurate
Signed: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Print Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Position in Organisation: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Attachment checklist
□ Copy of group constitution (if applicable)
□
Names and home addresses of 21 members registered to vote in nomination area
(if group is not constituted)
□ Site boundary plan (if possible)
□ Evidence of current community use e.g. activity programmes, website links
Please use and attach additional sheets of paper if you need to.
Thank you for your nomination.
We will acknowledge receipt of your nomination and will also check through your form
and let you know if any further information is required. If you have not received an
acknowledgement within five working days, please contact us on the email
address below.
For any further information or advice in filling in the form check our website:
www.somersetwestandtaunton.gov.uk
Please email this completed nomination to
Enquiries@somersetwestandtaunton.gov.uk