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STATEMENTOFCANDIDACY2016DNC Name: County: under: SD# G MF Address: City: Zip: Age: DateofBirth: / / PreferredPhone: () () Cell: Email: VoterRegistrationNumber: Circleonecategorywhichmostcloselyappliestoyouandforwhichyouwishtobeconsidered:
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1972 TitleofOffice PledgedAtLargeDelegate IcertifythatIvoted Forthosewhodidnotvot ElectedOfficial PledgedParty STATEMENTOFCANDIDACY2016 Pleaseconsidermeinth checkthoseapplicable PledgedSenatorialDistr IswearthatIhavenot votingyear Sworntoandsubscribedbe t

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