NOMINATING PETITION FOR MUNICIPAL ELECTION ~J

Transcription

1 NOMINATING PETITION FOR MUNICIPAL ELECTION ~J 1 ~l,_\i)(.l'{ INSTRUCTIONS TO CANDIDATE: The heading of this petition and the declaration of candidjcy must e fully completed before the petition is circulated for signatures. WE, THE UNDERED qualified voters of the municipality of Brookings in the state of South Dakota, nominate Keith W. Corbett whose residence address is 1122 Telluride Lane Brookings, South Dakota, and whose mailing address is 1122 Telluride Lane, Brookings, South Dakota, as a candidate for a 3 -year term for the office of Mayor at the Municipal Election to be held on the 1oth day of April 2018 DECLARATION OF CANDIDATE I, Keith W. Corbett (print name here exactly as you want it on the election ballot) under oath, declare that I reside and am registered to vote in the municipality of Brookings and that I am eligible to seek the office for which I am a candidate. If nominated and elected, I will qualify and serve in that office. If I am an alderman candidate, I declare that I reside and am registered to vote in Ward _6_. '1 -r: (Signe~~::...=~~~::::..:...=... _ Sworn to before me this@ day of JMU~, Zol.(/"'~ (Seal) Qf}hcu, 7hc:-rr;~ My Commission Expires ~ ;2 7, ;:lol?{ Si nature ~f i)fficer Administering Oath ~K- Title of Officer Administering Oath INSTRUCTIONS TO ERS: 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 rovide all information re uested rna invalidate the si nature. DATE/COUNTY J : f ~--=--L~ SlN()L~ L-' ~ f1, '17 vh I I fr' /..:::>p '--tx"j o. r f'-. } :f': ' )_/.c: Ui'("/ rz.krf/1\ CIT):,ORTOWN t..sfoo\c-\n s 5.r> 57ool:J {- z..~p-;f3 Broo c_, (\! :=_!/ > 5o ~ Lt CO~Y OF ~<;!ISTRATION (' f'\ /.) V'<!>t) /{_ lf\ ) :::,, f-j _... Ld_Co. :1~

2 NAME RESIDENCE ~~62~ ~ ~-~ze_::~::~:~:~~_p;_:~a~2~3:~ CIJX OR TOWN ~c.....!.. w, l.=lo.~. d.s..,... tstft4 rz \.t f ~ 5 D 5'7tJt? ~ STREET AND NUMBER ~UKAL ROUTE AND BOX NUMBER DATE/COUNTY!_l?: <::_{_!._k _ /3,rcoL,,"...,.., J J Ll2_{_l!.t8 _ CO,\JNTY OF REGISTRATION tsrc- ~~~ <, _/.! :~~B17Jk COU F RE ST ifion n-,. n 'l.i.j v ' VERIFICATION BY PERSON CIRCULATING PETITION INSTRUCTIONS TO CIRCULATOR: This section must be completed following circulation and before filing. u)u._\ ~ /<.. ~4v \U~,-0 'f?ij7 Q.~<:..<?rJc'f CoJfL1 HR.<.:lO\L\,Nb) s. 0 Print name of the circulator Residence Address City State I, under oath, state that I circulated the above nominating petition, that each signer personally signed this petition in my presence, that either the signer or I added the printed name, the residence address of the signer, the date of signing, and the county of voter registration, that I attest the legality of the signatures and that each person signing this petition is a qualified voter of the municipality of Brookings 1J!)1! r--~ :...[[, -.- Signature of Circulator Sworn to before me thi~ day offului.lf,wi d; n.. (Seal) nei...&~ vc ~ Signatur5; o Offjc;~r Ad~inistering Oath My Commission Expires Lf/ d 7 {1 /; Fonn Revised :02:08:13 [ba~ Title of Offic r Adtmmstenng Oath

3 NOMINATING PETITION FOR MUNICIPAL ELECTION ~),~i))i'~j)iq INSTRUCTIONS TO CANDIDATE: The heading of this petition and the declaration of candidacy must e fully completed before the petition is circulated for signatures. WE, THE UNDERED qualified voters ofthe municipality of Brookings in the state of South Dakota, nominate Keith W. Corbett whose residence address is 1122 Telluride Lane Brookings, South Dakota, and whose mailing address is 1122 Telluride Lane, Brookings, South Dakota, as a candidate for a 3 -year term for the office of Mayor at the Municipal Election to be held on the 1oth day of April 2018 DECLARATION OF CANDIDATE I, Keith W. Corbett (print name here exactly as you want it on the election ballot) under oath, declare that I reside and am registered to vote in the municipality of Brookings and that I am eligible to seek the office for which I am a candidate. If nominated and elected, I will qualify and serve in that office. If I am an alderman candidate, I declare that I reside and am registered to vote in Ward _6_. (Sign~~~ Sworn to before me this~ day of~ 2Q1 2( ---=-..::...:: (Seal) CJ cz2acll+7h c.r~y=j Signature of Officer Administering Oath :tv1ycornrnissionexpires ~:l-7,;;2017 ~ ~ ~ --vrftle of Officer Administering Oath INSTRUCTIONS TO ERS: 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 rovide all information re uested rna invalidate the si nature. NAME RESIDENCE DATE/COUNTY? ~_f tiu.t:.!:f:_/:! c.!i'!._(: #.! q_! 1 cr;.,or TO Pr<>o.) fj) -: gf :/._f. 8rool'. r....! DATE OF IN.. L~_2:_f._:-!B. \ STREET AND NUM OR RURAL ROUTE AND BOX NUMBER 3 L.If..~ ( /f')-wfj# J />t CITY ~TOWN b < J.. t7 e..h CS1 Vt ; V" I< f":j,..f),,_,, l't ;. ~ k!". Pv J.._, ;t-.._a ~ :::. =--D-=--= STREET AND NUMBER OR RAL ROUTE AND BOX NUMBER!_~-~-~----y_~--~-~--AV..f:.tf._"!. (",C'<"'1 a ll.cotl-t.) b "J,eo STREET AND NUMBER OR RAL ROUTE AND BOX NUMBER _./_Z_If.f! d~!!!t!i?l'e... ~-44~ cnyor TOWN COUNJ;.Y OF REG,IS}RA TION t~rpeo Plf 1,.. c:. ~b van 2.o 18. Yl,.60~tfl.l (j-. S ( -: ~-~---:_ ---~-~t:tf:.. s,..,,,.r.;. _, l.l.!?:-i?.l.~-~, -n;-,. ~ IJ-t - I.. ~A J ~--':..L.~ l ~~ ')

4 RESIDENCE DATE/COUNTY ( :~-~- -=-~~_(! _ COU Y OF REqi}TRATION U(VOJC.I fl..s L_:: k {_~1: ~/_f _ r ( : _ ~-~-=( ~ J :_Z_l.e.:L~ :2_~ _:._(_" : , Ol ret } 0 Y. V_;-G_)/\ IJ '() (',.._ ~ ) ~----~ 'f \S\\ V\ b \s G\" ox d ~ ~ c. \Wt k- M \ y STREET AND NUMBER ORR RAL OUTE AND BOX NUMBER?.~-~-----(~-~--~~--~~o~2±h \.w..)gs -5 D S(OOI..o B._fu~-~-~:?2-~ (p - 1 L_-:?:_~ -::-_l?. _ COUNU:, OF REGISTRA TtON \5ve)O,... SIG~~ /_4_,4d_ 28,?: ~!':.V.... = PR T 1J :::f SSc VII-" );.S7A[) STREET AND NU~ER OR RURAL R UTE AND BOX NUMBER.:1\$ \ L ~ --~ CIT"{PR TO\Vli Ot"~tl\(...~1'\?_l:'::i ~?!!! ~----? _ :.y[j.:5. SD 57&~tJ 6 c' ~~~Jt116)Q_'1f_R-:: -~ -- 1:_1:~_:_\ ~ c CO~TY OF REGISTRATION J) 1Z co ;t!:,mvg$ f_~q_f ::_(_?! C~JlNTY OF REGISTRATION /J;?, v<j:a/u 5> DATE OF ~IGNING!_:&.:ll _ VERIFICATION BY PERSON CIRCULATING PETI ION INSTRU TI.9NS TO CI ;t ~ u Residence Address I, under oath, state that I circulated the above nominating petition, that each signer personally signed this petition in my presence, that either the signer or I added the printed name, the residence address ofthe signer, the date of signing, and the county of voter registration, that I attest the legality of the signatures and that each person signing this petition is a qualified voter of the municipality of Brookings s_worn to b~fore ~e this ;jtp, day of ~I!JAf., (Seal) -_. M)-. ~omln.ission Expires #sp 2D Form r.,evisl.!d 20,15-5:02:08:13 d. Title of

5 NOMINATING PETITION FOR MUNICIPAL ELECTION ~J '\>}'-'\d-6\>( INSTRUCTIONS TO CANDIDATE: The heading of this petition and the declaration of candidacy must be fully completed before the petition is circulated for signatures. WE, THE UNDERED qualified voters of the municipality of Brookings in the state of South Dakota, nominate Keith W. Corbett whose residence address is 1122 Telluride Lane Brookings, South Dakota, and whose mailing address is 1122 Telluride Lane, Brookings, South Dakota, as a candidate for a 3 -year term for the office of Mayor at the Municipal Election to be held on the 1oth day of April 2018 DECLARATION OF CANDIDATE I, Keith W. Corbett (print name here exactly as you want it on the election ballot) under oath, declare that I reside and am registered to vote in the municipality of Brookings and that I am eligible to seek the office for which I am a candidate. If nominated and elected, I will qualify and serve in that office. If I am an alderman candidate, I declare that I reside and am registered to vote in Ward _6_. (Signe~::...:o~~~:..:::.JO:::.!~::.. Sworn to before me thi~ day of 0u..n~ Wt 8"' (Seal) ~ 7J?~ ~IJ t-- Si naturypfoffiq~ Administering Oath My Commission Expires ~.;2-I,..::J..,o I o ~..._ itle of Officer Administering Oath ll"vjstructions TO ERS: 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 ofthe 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 rovide all information re uested rna invalidate the si nature. NAME RESIDENCE DATE/COUNTY CITY-QR TOWN.-r-t./ ~'"cjv,aiv :t 50.J t'vl!> STREET AND NU BER OR RURAL ROUTE AND BOX NUMBER l.'l?>3.. :ze.~---424~ CITY R TOWN sf) ' ci~rl-owni ljyoor,;"".s COWTY OF r~istration D r'od ',.....s ( / f-2(...--fo c

6 DATE/COUNTY n} 5 OUTE AND BOX NUMBER STREET AND NUMBER OR RU l7~f y~ STREET AND NUMBER OR L ROUTE AND BOX NUMBER 51- URAL ROUTE AND BOX NUMBER ~-~----~---~~-.~ J f! ~_g ~-~-~-~---~ l-7 ' PR!NT ( c- 0 C.<:"vL #/... ~) CIT~ TOWN fj ij o Df-.fCcA) K.')i'C!. ~.S'~~ d ~ -:: _(( OF REGISTRATION I> /(!!,e. 6../::. N e,._ SI{JJ ~ D-~ ?n ( ~ s / e t ~I? 5o l PR!NT 1. -:: CO~, - t3[t K ~ COiTY OF REGjSTRATION -2-p-f~ _ :~r:._~~~-! 2 C TY OF REGISTRATION ( N-/h-t.tv'~ COUNTY L: l_u(._:::_l~ of REGISTRATION '(OO DA E OF ING --~~-~::.~~--!~--~-~-= COI)l>lfY OF REGISTRATION 9.:S t/1(1c/it. /~ "-- ~~&h.l m-a., A l L.b-lR ~co(\.~ ST Q._1~ p_a~_ d_erj:!qi~ f?.ass ompleted folio Print name of the circulator Sworn to before me this (Seal) J::iL day of My Commission Expires FormRevised2015-5:02:08 :13.Jc."lV"r) Lf- ~ ~- Z. ~ Title of Officer Administering Oath (rf--

7 NOMINATING PETITION FOR MUNICIPAL ELECTION ~.~ ~\\l:.j INSTRUCTIONS TO CANDIDATE: The heading of this petition and the declaration of candidacy must be fully completed before the petition is circulated for signatures. WE, THE UNDERED qualified voters of the municipality of Brookings in the state of South Dakota, nominate Keith W. Corbett whose residence address is 1122 Telluride Lane Brookings, South Dakota, and whose mailing address is 1122 Telluride Lane, Brookings, South Dakota, as a candidate for a 3 -year term for the office of Mayor at the Municipal Election to be held on the day of April 2018 DECLARATION OF CANDIDATE I, Keith W. Corbett (print name here exactly as you want it on the election ballot) under oath, declare that I reside and am registered to vote in the municipality of Brookings and that I am eligible to seek the office for which I am a candidate. If nominated and elected, I will qualify and serve in that office. If I am an alderman candidate, I declare that I reside and am registered to vote in Ward _6_. (Signed)~ g v&~ Sworn to before me this Jfz_ d~: of TCLn ~ z.:o I B (Seal) cijfjcw; /h.n-~ ~ejq~offic~ dministering Oath My Com..rnission Expires ~ :J I, 'J-ot 8 -~ ~~ itle of Officer Administering Oath INSTRUCTIONS TO ERS: 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 ofthe 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 rovide all information re uested rna invalidate the si nature. NAME RESIDENCE DATE/COUNTY I -'1L~ ~ ~-~~-----~~-~-~~-~~S----~ /.:::- 2 ~ : {_~ PRJNT c 5 tewc:vv'l CIT" ~~KliJ> SD :51oab 8u~~gpn:;5oN STREET AND lber OR RURAL ROUTE AND BOX NUMBER _ q_1!.'dg:_e );;;e _f_::-af:-:_~{ CIT OR TOWN COU Y OF REGISTRATION f(:}ij ' /Y1 ' lc) ST EET AND NUM R RURAL ROUTE AND BOX NUMBER /.Q ~_fl 2~s 4:~-~ CITY~ TOWN {. _ J5 12-oc <..t vt $. /L_j_L 1(.: A.:!:_: {D RURAL ROUTE AND BOX NUMBER ) j_qvt_v-e.l Ierne- L~--~-2---=-~--r _ COU.J;l:j OF REGI~T~ TION D/2-o o lz <'VL -s 1/ -! ;}1_ _ Bv--tJ.,r(, t'\ STREET AND NUMBER RURAL ROUTE AND BOX NUMBER!}?: "? ~q-~-~-~_l f::~--~-s::-::- L =--~-7::!_?: s s v 57t:JCJ ~ DATE OF IN l : 2:~:_! [ cou

8 NAME RESIDENCE STREET AND NUMB ER OR RURAL ROUTE AND BOX NUMBER _ J_ttfL _ CITYO WN &i.lfuta~---lt2 - -=-t!e~a DATE/COUNTY :~:~\It1_!_L(S _ C TY OF REGIS~RATION t>~o.~os ]), fill\ l 'D C~TY OF REGJ}'j;IV\',FION It/ /'C) t? It:- t.17 c:._s Lf_~2/2~ C~TYOFfEG~TRA~ ON k:$/r-0(),'<. ~ h C-. co :2/ ~0:~--- TY OF REGISTRATION it ~~~ ii:.. ~ _Q rt2c r{ [)f~ort ---~&till : L:_!f-_Z:::Lf v::3 v-t>l.j X r' STREET AND NUMBER OR RURAL ROUTE AND BOX _ L_/_& _ C(_{]_dztz0::: _ MBER t4 ~ NSTRUCTIONS TO CIRCULATOR: This section must be completed followin circulation and before filing. t1t: X. 7/5&11 J &7 3 iu1 /; f /;;; /f;:5s tr.:? A'ln.w s s D Print name of the circulator Residence Address City State I, under oath, state that I circulated the above nominating petition, that each signer personally signed this petition in my presence, that either the signer or I added the printed name, the residence address of the signer, the date of signing, and the county of voter registration, that I attest the legality of the signatures and that each person signing this petition is a qualified voter of the municipality of Brookings Sworn to befo;e m0 this l_ day of~ _- (SeaQ iviy Cotnrnission Expires 1/13/J-o.ZO Form Revised :02:08:13 Signature of Circulator ',;;Jjf Signature of n:jlcer Administering Oath Alb~ iil/i/0 Title of ficer Adm1mstermg Oath

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11 NOMINATING PETITION FOR MUNICIPAL ELECTION o\q ;:;IN~s=T=R=u;-;-:;::c=T=Io=N:o-=S---;:T;::;-;0:::;--;:C;--;A:-.:N"D~ITTD'A.--;T;:;::;cE;:::;--;:T:;:;;h'e'h'e-a'd~in-g-o"""'f:-:-;th"i-s-p----:et-.-:it-.-io_n_a-n'd--:-th'e----.-de-c'la:-r----:at:-:-io-n-o-:-:;f"c:-::-an-d-::;;i"d-::-; azt-:fi '::::1:~'\\T-rP fully completed before the petition is circulated for signatures. WE, THE UNDERED qualified voters of the municipality of Brookings in the state of South Dakota, nominate Keith W. Corbett whose residence address is 1122 Telluride Lane and whose mailing address is 1122 Telluride Lane, Brookings, South Dakota, as a candidate for a 3 -year term for the office of Mayor Brookings, South Dakota, h day of April 2018 at the Municipal Election to be held on the DECLARATION OF CANDIDATE I, Keith W. Corbett (print name here exactly as you want it on the election ballot) under oath, and that I am eligible to declare that I reside and am registered to vote in the municipality of Brookings seek the office for which I am a candidate. If nominated and elected, I will qualify and serve in that office. If I am an alderman candidate, I declare that I reside and am registered to vote in Ward _6_. Sworn to before me this d ~day oflu/j~ (Signed~--=~'----="~-~-=-->t._==-.2L?1 ~ d!j~ Jhw-~ (Seal) ~ n 1/ M~~. Commission Expires -~-+---.r 11 o&- 0 ig ature _9f _9ffice~~dministering Oath I t' ~r~ itle of Officer Administering Oath - INSTi~UCTIONS TO ERS: 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. Ifthe 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. Failu.!_e to _Q~ovide all information requested may invalidate the signature. NAME RESIDENCE..-..-I:)AfE/eotJNTY ST~AND NUMBER OR RURAL ROU~OX NUMBER CI ~-J-~ ~ c TY OF REGISTRATION LL,a ~\.~ R TOWN \ 1 Y~\UVI STREET AND NUMBER ORR R I. Zl~ I d' ROUTE AND BOX NUMBER q-~' 51'" CITYOR~ J/- l:jyocft.~'-' STREET AND NUMBER OR RU L ROUTE AND BOX NUMBER _b3l...si~t~~::r;~-----~?.~~-.?.: L_=~s.J_B. ~_QRTOWN. J.5/-.01..S'(-Ir~ S. '5-tcN (o ~- L~J>-..---~-d~~'j!_~ c }_c 50 J- 30 -If>' 57~ 6 ca:u-iv--=-.1 ifonf. STREET AND NUMBE R RU t: ROUTE AND BOX NUMBER c~-~~-wn~~l'!f_~_ &; D

12 NAME ~ IS ~.JI.... ~ st.ev t-.. L-1 'Ytf~ _~~~ I ~RiNT ,- --, /11 fl-'f+ N) u<, h h~t..d. ~ lsl.:~ ~ P~ JtJ-c" /' ~/I'A. r RESIDENCE ';1_6 f ::tt:jdla.o. tf:ri.l9.. i.?ft._~ citvw TOWN,./5F"OOkl~tA.S 5})~ STREET AND NUMBE~ RURAL ROUTE AND BOX NUMBER ~~ o II f.b Av-e J CITYO~~~~J f"f) STREET AND NUMKER OR RURAL ROUTE AND BOX ~ER \_1:2:3... ~-~ -~------b CITY ~WN I- _....,...,._ :e.rat>k~(, ~\ _) S 'lc-c>b STREET A."lO Nu;:rJER OR IWRA I!:' P.OUTE AND BOX NV~1BER :!:.!.~-~- - {!!l~f..!~ J-/ g s. ClT).CQR TOW!j_ l:::f /!..ej() JC-1 ~{ c;p ST~ET AND NUMB~ OR R.URAL JGUTE AND BOX NUMBER o' 33c2 // ~{./14~ _>, ~ /..f2.. CITY WN //\?e.)/~, "7 > STREET AND NUMBER ORIRURAL ROUTE AND BOX NUMBER DATE/COUNTY "7 ~.J -:zo;;' ~----..c::l BrooJd --ta.s --/ Z-1 U_VJ1f ~ COUNTY OF II GIS;JATION Yl r-'"" JG-f ;.-].} DAT~ OF SiGi'iiNG Qea,/C/Y1 <is / , l COUNTY OF REGIS'fRATION VERIFICATION BY PERSON CIRCULATING PETITION IN~ RUCTIQN.S TO CIRCULATOR: This section must be completed following circulation and before filing. /~,~;tt LJ(~tl'le ~ //cc:. 7C~r(" ~./,._- /&'OcJb-' s 0 Print name of the circulator Residence Address City State I, under oath, state that I circulated the above nominating petition; that each signer personally signed this petition in my presence, that either the signer or I added the printed name, the residence address of the signer, the date of signing, and the county of voter registration, that I attest the legality of the signatures and that each person signing this petition is a qualified voter of the municipality of Brookings '. ~wqm to,befoieme this :/_/ _. (Seal),rv1y Commission Expires J/;j2o2f) ~iiilu Revise<l2Di5-5:02:08:13 day of b llabo ~~ Signature of Circulator, doll?~. w~ &J>a-tfttlkt Signature of Of cer Adm1mstenng Oath M6z?t fl JJaizl/ ( / Title of Of cer Admm1stermg Oath

13 NOMINATING PETITION FOR MUNICIPAL ELECTION ~~~~~~~~~~~~~~ INSTRUCTIONS TO CANDIDATE: The heading of this petition and the declaration of candi full com leted before the etition is circulated for si natures. WE, THE UNDERED qualified voters of the municipality of Brookings in the state of South Dakota, nominate Keith W. Corbett whose residence address is 1122 Telluride Lane Brookings, South Dakota, and whose mailing address is 1122 Telluride Lane, Brookings, South Dakota, as a candidate for a 3 -year term for the office of Mayor at the Municipal Election to be held on the day of April 2018 DECLARATION OF CANDIDATE I, Keith W. Corbett (print name here exactly as you want it on the election ballot) under oath, declare that I reside and am registered to vote in the municipality of Brookings and that I am eligible to seek the office for which I am a candidate. If nominated and elected, I will qualify and serve in that office. If I am an alderman candidate, I declare that I reside and am r~eis~ ole in Ward _6_. - (Sign ~/c// ~ Sworn to before me thi~ day of JCU'I ~ _ ,- -, (Seal) Wa~ 7hP!/~ d/ff1 ~k_ - Signatu~o_f Officer Administering Oath _ M;:_ Co~ission Expires ~ ;2. 7 r ~01 lf' Title of Officer Administering Oath INSTRUCTIONS TO ERS: 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 rovide all information re uested rna invalidate the si nature. 1 :s 1 o vv "' ~fi/ V1 fl/\ s; citv "op.-to"wn- 7};. ~ --~_, ""f--~- -;;;_ ~ STREET AND NUMBER OR RURAL UTE AND BOX NUMBER ~--~-~--~----~-q~-~-~~-h p_~ CITY OR TO\'{_~..J:>,'C>t:>k 'vv.'-:::. S[) STREET AND NUMBER OR RU L ROUTE AND BOX NUMBER _l(j_f ;fi_4!.'!.':j...f!.~~~ !J.d... CITY 9)'- TOW)'I J/J J" I /.Yc.9o4/,.f v Joob STREET AND NU BER OR RURAL ROUTE AND BOX NUMBER.../M.~--d~J/4' } ~~:... COUNTYJV' REGISTR,ATION Y5,~ b ok: 1 \ z"l-1'6 COUNTY,9F REGISTRATION P/"~j..Ct.\..., _s....l.::... d.~--~-1!. 1 -~.;;.c;-;p CO~Y OF REGISTRATION.r/--:)rec.: e::.~e,;z:e.ac>c--..s. I - d -9-; f STREET AND NUMB ROR RURAL ROUTE AND BOX NUMBE ~; \,; :,< 'DATE.OF.ING " JI : 'f ~{,:,..,;.'!:;,..-\ '. :-,.-:, r,~,'j.o;.,;. ;,;\ \_.'l '!:.. j' c.:j ; )~,,_.~J:~; :. > <.,

14 NAME RESIDENCE DATE/COUNTY COUNTY OF REGISTRA T!ON 18 - COUNTY OF REGISTRA T!ON I (g... 2Q """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" COUNTY OF REGISTRA T!ON VERIFICATION BY PERSON CIRCULATING PETITION INSTR CTIONS TO CIRCULATOR: This section must be co;ppleted following circulation and before filing. e Ct.-,-.,. LeL- 3/oWc,h r.{c..ss rock, 5 Residence Address Ci State I, under oath, state that I circulated the above nominating petition, that each signer personally signed this petition in my presence, that either the signer or I added the printed name, the residence address of the signer, th~, ty of voter registration, that I attest the legality of the signatures and that each pe on~~tlh 9~/H~s rualified voter of the municipality o Brooki s. ~NOTARY PUBLIC~ ~SOUTH DAKOTA~ ""'~,_.,... Sworn to before me this JlL_ day of_..0-= I(M'--'!..., (Seal) My Commission Expires Vz -\ l "1 ~ Form Revised :02:08:13 Title of Officer Administ ring Oath