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NOMINATING PETITION
__________________________________________________________________________________________
INSTRUCTIONS TO SIGNERS:
1. Signers of this petition must individually sign their names in the form in which they are registered to vote
or as they usually sign their names.
2. Before the petition is filed, each signer or the circulator must add the residence address of the signer and
the date of signing. If the signer is a resident of a second or third class municipality, a post office box may be
used for the residence address.
3. Before the petition is filed, each signer or the circulator must print the name of the signer in the space
provided and add the county of voter registration.
4. Abbreviations of common usage may be used. Ditto marks may not be used.
5. Failure to provide all information requested may invalidate the signature.
NAME
RESIDENCE
DATE/COUNTY
SIGN

1 -------------------------------------------------------------------------------------------------PRINT
SIGN