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  • Neil's Petition

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    Paula DeWild
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    This 3 sentence summary provides the essential information from the document: This document is a petition form for Nel Anderson to be listed as a Republican candidate for the Illinois House of Representatives for the 72nd District in the March 20, 2012 primary election. The form includes spaces for signatures, addresses and other information from registered Republican voters in the district to nominate Anderson as their candidate. At the bottom, a circulator certifies that they witnessed the signatures and that the signers were qualified to vote in the Republican primary for that district.

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    This 3 sentence summary provides the essential information from the document: This document is a petition form for Nel Anderson to be listed as a Republican candidate for the Illinois House of Representatives for the 72nd District in the March 20, 2012 primary election. The form includes spaces for signatures, addresses and other information from registered Republican voters in the district to nominate Anderson as their candidate. At the bottom, a circulator certifies that they witnessed the signatures and that the signers were qualified to vote in the Republican primary for that district.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    29 views1 page

    Neil's Petition

    Uploaded by

    Paula DeWild
    This 3 sentence summary provides the essential information from the document: This document is a petition form for Nel Anderson to be listed as a Republican candidate for the Illinois House of Representatives for the 72nd District in the March 20, 2012 primary election. The form includes spaces for signatures, addresses and other information from registered Republican voters in the district to nominate Anderson as their candidate. At the bottom, a circulator certifies that they witnessed the signatures and that the signers were qualified to vote in the Republican primary for that district.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    of 1

    . - ._-- _.

    '-,

    - -..
    REPRESENTATIVE IN THE GENERAL ASSEMBLY PRIMARY PETITION

    ....~~-..., .. ... Revised May, 2009 SSE No. P-13

    l/JJ.e, I,tndersigned, members of and affiliated with the Republican th~ Party and qualified primary electors of the ReWUDlican Party, in the 72nd Representative District of the State of Illinois, do hereby petition that Nel Anderson who resides at 2531 23rd Avenue in the City, Village, UnincorporatedArea (circle one) of Rock Island (if unincorporated,list municil2.ality thalProvides postal service) Zip Code 61201 County of Rock Island and State of Illinois,shall be a candidate of the He ub Ican Partyfor the nomination for the office of REPRESENTATIVE IN THE GENERAL ASSEMBLY of the State of Illinois, for the 72n Representative District to be voted for at the primary election to be held on March 20. 2012 (date of election). If required pursuant to 10 ILCS 5/8-8.1, complete the following (this information will appear on the ballot) FORMERLY KNOWN AS (List all names during last 3 years) NAME (VOTER'S SIGNATURE) 1 2 3 4
    5 6
    7

    UNTIL NAME CHANGED ON ---:::-:-:-~:---:----:- __ -:-_-:-(List date of each name change) CITY, TOWN OR VILLAGE
    IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL

    STREET ADDRESS OR RR NUMBER

    COUNTY

    8 9

    10 11 12 13 14 15 State of County of I, _ _ SS. (Circulator's Name) do hereby certify that I reside at

    in the CityNiliagelUnincorporated Area (circle one) of

    (If unincorporated, list municipality that provides

    postal service) Zip Code , County of , State of that I am18 years of age or older, that I am a citizen of the United States, and that the signatures on this sheet were signed in my presence, not more than 90 days preceding the last day for filing of the petitions and are genuine and that to the best of my knowledge and belief the persons so signing were at the time of signing the petition qualified voters of the Party in the political division in which the candidate is seeking nomination/elective office, and that their respective residences are correctly stated, as above set forth.

    Signed and sworn to (or affirmed) by (Name of Circulator) (SEAL)

    (Circulator's Signature) before me, on ---::---:---::---:----7"". (insert month, day, year) (Notary Public's Signature)

    SHEET NO.

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