Fillable Nomination Petitions And Affidavit (City of Marshalltown (IA))

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Nomination Petitions And Affidavit (City of Marshalltown (IA))

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Prescribed by the Office of the Iowa Secretary of State Revised 5/2019
State of Iowa
Affidavit of Candidacy
Candidate’s Name (exactly as it should appear on the ballot – no titles, parentheses, or quotation marks):
Candidate’s Name Sounds Like (phonetic spelling):
Office Sought: District or Ward (if any):
Vacancy – Is the candidate running to fill a vacancy due to the death, resignation, Yes No
removal, or temporary appointment of an office holder?
Type and Date of Election:
Primary on ____/____/____ General on ____/____/____
City/School on ____/____/____ Special on ____/____/____
Candidate’s Affiliation (only complete for partisan offices or Ch. 44 city nominations):
Democratic Republican
Not affiliated with any organization
Name of Non-Party Political Organization:
No more than 5 words and exactly as it should appear on the ballot.
Candidate’s Home Address:
Street (no P.O. boxes) City State Zip County
Candidate’s Mailing Address (if different than above):
Street City State Zip County
Candidate’s Phone: Email:
Candidate’s Affirmation
I swear (or affirm) that the information provided on this form is correct. I will be qualified to hold this office and if I am elected, I
will qualify by taking the oath of office. I know that I cannot hold public office if I have been convicted of a felony or other
infamous crime and my rights have not been restored by the governor or by the president of the United States.
I know that I am required to organize a candidate’s committee, which shall file an organization statement and disclosure reports
if I (or my committee) receive contributions, make expenditures, or incur indebtedness in excess of $1,000 in a calendar year for
the purpose of supporting my candidacy for public office. (This does not apply to candidates for federal office.)
I know that I cannot be a candidate for more than one office to be filled at this election (except in the case of county agricultural
extension council or soil and water conservation district commission).
Candidate’s Signature:
Must be signed in the presence of a notary.
State of: ____ County of: _______________
(Stamp)
Signed and sworn (or affirmed) before me on date of: _____________
By:
Print Candidate’s Name
Notary Signature: , Notary Public or authorized notary under §9B.10
COUNCIL
11
05
19
MARSHALLTOWN
IA
50158
64
IA MARSHALL
Office Ward (if any): Office District (if any):
Name: _________________________________________ Signature: _______________________________________
Address: ___________________________________________ Phone Number: ______________________________
State of Iowa
Nomination Petition for Non-Partisan Office
We, the undersigned eligible electors of the appropriate county, city, school district, school or community college director district, or other district
as established by law, and the state of Iowa hereby make the nomination outlined above. If the candidate named above accepts the nomination,
we believe the candidate is or will be a resident of the appropriate county, city, school district, school or community college director district, or
other district established by law as required by law.
Sign Your Name
Iowa Residential Address (where you live)
Today’s
Date
House Number and Street City
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Prescribed by the Iowa Secretary of State Revised 5/19
Candidate Information
Name
of Candidate: Office Sought: _
Candidate’s County of Residence: Candidate’s City of Residence:
Type and Date of Election:
Special on / /
City/School on /
/
Is the candidate running to fill a vacancy due to the death, resignation, removal, or temporary appointment of an office holder? No
Yes
For School Elections Only
School District:
School Director District (if any):
For City Elections Only
For Other Elections Only
General on / /
COUNCIL
MARSHALL
MARSHALLTOWN
■
11
05
19
Office Ward (if any): Office District (if any):
Name: _________________________________________ Signature: _______________________________________
Address: ___________________________________________ Phone Number: ______________________________
State of Iowa
Nomination Petition for Non-Partisan Office
We, the undersigned eligible electors of the appropriate county, city, school district, school or community college director district, or other district
as established by law, and the state of Iowa hereby make the nomination outlined above. If the candidate named above accepts the nomination,
we believe the candidate is or will be a resident of the appropriate county, city, school district, school or community college director district, or
other district established by law as required by law.
Sign Your Name
Iowa Residential Address (where you live)
Today’s
Date
House Number and Street City
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Prescribed by the Iowa Secretary of State Revised 5/19
Candidate Information
Name
of Candidate: Office Sought: _
Candidate’s County of Residence: Candidate’s City of Residence:
Type and Date of Election:
Special on / /
City/School on /
/
Is the candidate running to fill a vacancy due to the death, resignation, removal, or temporary appointment of an office holder? No
Yes
For School Elections Only
School District:
School Director District (if any):
For City Elections Only
For Other Elections Only
General on / /
COUNCIL
MARSHALL
MARSHALLTOWN
■
11
05
19
Office Ward (if any): Office District (if any):
Name: _________________________________________ Signature: _______________________________________
Address: ___________________________________________ Phone Number: ______________________________
State of Iowa
Nomination Petition for Non-Partisan Office
We, the undersigned eligible electors of the appropriate county, city, school district, school or community college director district, or other district
as established by law, and the state of Iowa hereby make the nomination outlined above. If the candidate named above accepts the nomination,
we believe the candidate is or will be a resident of the appropriate county, city, school district, school or community college director district, or
other district established by law as required by law.
Sign Your Name
Iowa Residential Address (where you live)
Today’s
Date
House Number and Street City
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Prescribed by the Iowa Secretary of State Revised 5/19
Candidate Information
Name
of Candidate: Office Sought: _
Candidate’s County of Residence: Candidate’s City of Residence:
Type and Date of Election:
Special on / /
City/School on /
/
Is the candidate running to fill a vacancy due to the death, resignation, removal, or temporary appointment of an office holder? No
Yes
For School Elections Only
School District:
School Director District (if any):
For City Elections Only
For Other Elections Only
General on / /
COUNCIL
MARSHALL
MARSHALLTOWN
■
11
05
19
Office Ward (if any): Office District (if any):
Name: _________________________________________ Signature: _______________________________________
Address: ___________________________________________ Phone Number: ______________________________
State of Iowa
Nomination Petition for Non-Partisan Office
We, the undersigned eligible electors of the appropriate county, city, school district, school or community college director district, or other district
as established by law, and the state of Iowa hereby make the nomination outlined above. If the candidate named above accepts the nomination,
we believe the candidate is or will be a resident of the appropriate county, city, school district, school or community college director district, or
other district established by law as required by law.
Sign Your Name
Iowa Residential Address (where you live)
Today’s
Date
House Number and Street City
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Prescribed by the Iowa Secretary of State Revised 5/19
Candidate Information
Name
of Candidate: Office Sought: _
Candidate’s County of Residence: Candidate’s City of Residence:
Type and Date of Election:
Special on / /
City/School on /
/
Is the candidate running to fill a vacancy due to the death, resignation, removal, or temporary appointment of an office holder? No
Yes
For School Elections Only
School District:
School Director District (if any):
For City Elections Only
For Other Elections Only
General on / /
COUNCIL
MARSHALL
MARSHALLTOWN
■
11
05
19
Office Ward (if any): Office District (if any):
Name: _________________________________________ Signature: _______________________________________
Address: ___________________________________________ Phone Number: ______________________________
State of Iowa
Nomination Petition for Non-Partisan Office
We, the undersigned eligible electors of the appropriate county, city, school district, school or community college director district, or other district
as established by law, and the state of Iowa hereby make the nomination outlined above. If the candidate named above accepts the nomination,
we believe the candidate is or will be a resident of the appropriate county, city, school district, school or community college director district, or
other district established by law as required by law.
Sign Your Name
Iowa Residential Address (where you live)
Today’s
Date
House Number and Street City
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Prescribed by the Iowa Secretary of State Revised 5/19
Candidate Information
Name
of Candidate: Office Sought: _
Candidate’s County of Residence: Candidate’s City of Residence:
Type and Date of Election:
Special on / /
City/School on /
/
Is the candidate running to fill a vacancy due to the death, resignation, removal, or temporary appointment of an office holder? No
Yes
For School Elections Only
School District:
School Director District (if any):
For City Elections Only
For Other Elections Only
General on / /
COUNCIL
MARSHALL
MARSHALLTOWN
■
11
05
19
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Nomination Petitions And Affidavit (City of Marshalltown (IA))

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Completed 13 July 2020

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