Application for Nomination by Primary
State of Wyoming )
) ss. W.S. 22-23-302
County of )
__________________, the undersigned, swear or affirm that I was born on
___________(month) ______(day), _______(year), that I have been a resident of the state of Wyoming since
_____________________ (month/year), and that I am a registered voter of Election District No. _________,
Precinct No. __________, in Ward No. _________, in the city of ___________________________, and the state
of Wyoming, residing at _________________________________________, as of the closing of the municipal
clerk’s office on the day this petition is filed, do hereby petition and request that my name be printed upon the
official municipal primary ballot at the next primary election as a candidate for the office of
_______________________________. I hereby declare that if nominated and elected, I will qualify for the
DATED the ________ day of ________________ , 20______.
Print or type your name exactly as you wish it to appear
on the ballot. (W.S. 22-6-111 states that professional titles
shall not appear on the ballot. Per Rules, Ch.
18, fictitious or pseudo names will not be allowed.)
In order to meet federal requirements for audio ballots
and to accommodate individuals with disabilities, please
print your name phonetically on the line above (i.e.,
Kyle Balcaen Wudson would be Ky-ill Ball-Kin Wood-Sin).
Mailing Address (if different from residential)
Mailing City/Town, Zip Code
Campaign Telephone (will be published)
Telephone Number (will not be published)
E-Mail Address (will be published)
• Please ensure that:
o You are not holding an office which may conflict, or be incompatible, with the office
for which you are filing.
o Your employment is compatible with the office you are seeking.
• Candidates for municipal office must be a registered voter and a resident of the municipality
and ward which he seeks to represent (W.S. 22-23-301) and will have resided in said ward for
at least one (1) year next preceding his election if so elected. (W.S. 22-23-103(b))
• Pursuant to W.S. 6-10-106, a person convicted of a felony is incompetent to hold any office of
honor, unless he has had a complete and full restoration of rights, not just voting rights. If you
have any questions regarding your ability to hold office, please ask the County Clerk for
May 14 through May 29, 2020
City or Town Clerk