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Form PF-A: CANDIDATE INFORMATION FOR THE OFFICE OF ELECTED SUPERVISOR
Washington State Conservation Commission, POB 47721, Olympia, WA 98504-7721
Revised: 2020
Form PF-A
CANDIDATE INFORMATION FOR THE OFFICE OF ELECTED SUPERVISOR
WAC 135-110-320
This information is required to determine your eligibility to fill the public office of conservation district supervisor. Your information will be verified by
the conservation district, and reviewed by the Washington State Conservation Commission. Please write legibly to avoid problems in determining
whether or not you are eligible for this office.
Your name
WAC 135-110-320(3)b
Day phone WAC 135-110-320(3)b
Cell phone WAC 135-110-320(3)b
Residential address
WAC 135-110-320(3)b
What is the name of the conservation district where you wish to serve? WAC 135-110-320(3)a
The conservation district is:
Are you a registered voter? WAC 135-110-320(3)c Do you live inside the conservation district? WAC 135-110-320(3)d
I am a registered voter in the county where the conservation district is located.
I reside inside the boundary of the conservation district.
Which type of candidacy do you choose? WAC 135-110-350; WAC 135-110-360 Check only one box below
I am running as a declared candidate and wish my name to be shown on the official ballot.
I am an undeclared write-in candidate. I did not submit the candidate required information to the conservation district by the filing deadline. I
am now submitting this candidate required information within four weeks (twenty-eight days) following the first date of election.
Are you a landowner or operator of a farm? WAC 135-110-320(3)e Check only one box below
I am a landowner or operator of a farm, as defined in the election procedures and WAC 135-110-110.
I am not a landowner or operator of a farm, as defined in the election procedures and WAC 135-110-110.
By my signature below, I swear under penalty of perjury under the laws of the State of Washington that the foregoing information is true
and correct. WAC 135-110-320(3)f
__________________________________________
Signature
_________________________________
Date
King Conservation District
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Completed 3 February 2022

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