For ___________________________________________________________
(Please print name of candidate.)
FOR THE OFFICE OF _________________________________________ Seat/Position ______________ for
the ___________________________________________________ District. This petition must be filed in the
office of the appropriate political sub-division filing office on or before 5 p.m. on the last day of filing for the
________________ Election. The submitted petition must have affixed thereto the names of at least five (5)
qualified electors which reside within the appropriate district or zone.
I, the undersigned, being a qualified elector of the _______________________________ zone/district,
in the State of Idaho, do hereby certify and declare that I reside at the place set opposite my name, and that I
join in the petition of ______________________________________________, a candidate for the office of
____________________________________, to be voted for at the election to be held on the _______ day of
______________, _______.
Signature of Petitioner Printed Name Residence Address Date Signed
1 _______________________________________________________________________________________
2 _______________________________________________________________________________________
3 _______________________________________________________________________________________
4 _______________________________________________________________________________________
5 _______________________________________________________________________________________
6 _______________________________________________________________________________________
7 _______________________________________________________________________________________
8 _______________________________________________________________________________________
9 _______________________________________________________________________________________
10 _______________________________________________________________________________________
County of ____________________________
I, ______________________________, being first duly sworn, say: That I am a resident of the State of
Idaho and at least eighteen (18) years of age; that every person who signed this sheet of the foregoing petition
signed his or her name thereto in my presence; I believe that each has stated his or her name and residence
address correctly, that each signer is a qualified elector of the State of Idaho, and a resident of the county of
Signed __________________________________________
Mailing Address ___________________________________
Subscribed and sworn to before me this _______ day of __________________, _________.
(Notary Seal) Signed __________________________________________
Notary Public Residing at ___________________________
EC-1B, Approved Secretary of State, July 2014
Commission Expires _______________________________