INDEPENDENT PETITION NOMINATION BY PETITION FOR GENERAL ELECTION REQUIRED NUMBER OF SIGNATURES:

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1 1 Atlantic County Clerk's Office EDWARD P. McGETTIGAN, COUNTY CLERK 5901 Main St Mays Landing, NJ FAX NOMINATION BY PETITION FOR GENERAL ELECTION REQUIRED NUMBER OF SIGNATURES: Please contact the Atlantic County Clerk's Elections Department (609) , extension 5231, for candidate petition information. The required number of signatures on petitions may vary according to districts and office sought.

2 2 NOMINATION BY PETITION FOR GENERAL ELECTION NOTE: This petition may be copied for voters signatures, but every petition shall have attached to it the affidavit of at least on signer stating that the other signers have signed the petition in good faith and that he or she actually saw the voters sign the petition (NJSA 19:13-7). NOTE: All candidates are required by law to comply with the New Jersey Campaign Contributions and Expenditures reporting Act. For further information please call (609) , New Jersey Election Law Enforcement Commission (NJSA 19:23-7). NOTE: no person shall be eligible to become a candidate for any local elective office, or be appointed to any local elective office unless he is registered to vote in the local unit to which the office pertains, and has been a resident of that local unit for at least 1 year immediately prior to the date upon which the election for the office is to be held, or prior to the date upon which the appointment is made, as the case may be. (NJSA 40A:9-1.13) TO THE HONORABLE,COUNTY CLERK We, the undersigned, hereby certify that we reside in Atlantic County, in the State of New Jersey, and we are legally qualified to vote for such candidates, and pledge ourselves to support and vote for the person named in such petition, and that we have not signed any other petition of nomination for the primary or for the general election for such office, and request that you cause to be printed upon the official general election ballot the name of the candidate and his designation of party or party principle. SLOGAN DESIRED: Must not exceed 3 words Must not exceed 46 total spaces We further certify that the name, place of residence and post office address, and the title for which said candidate is named, are as follows (NJSA 19:13-4) TITLE OF OFFICE SOUGHT NAME STREET ADDRESS P.O. BOX ADDRESS MUNICIPALITY ATTENTION: PETITION SIGNERS YOUR PRINTED NAME AND ADDRESS AS WELL AS YOUR SIGNATURE MUST APPEAR ON THE FOLLOWING PAGES FOR VERIFICATION PURPOSES Rev 2/05

3 3 NAME OF CANDIDATE: TITLE OF OFFICE SOUGHT: 1. Signature Printed Name 2. Signature Printed Name 3. Signature Printed Name 4. Signature Printed Name 5. Signature Printed Name 6. Signature Printed Name 7. Signature Printed Name Printed Name 8. Signature Printed Name 9. Signature Printed Name 10. Signature Printed Name 11. Signature Printed Name 12. Signature Printed Name 13. Signature Printed Name 14. Signature Printed Name 15. Signature Printed Name

4 4 NAME OF CANDIDATE: TITLE OF OFFICE SOUGHT: 16. Signature Printed Name 17. Signature Printed Name 18. Signature Printed Name 19. Signature Printed Name 20. Signature Printed Name 21. Signature Printed Name 22. Signature Printed Name Printed Name 23. Signature Printed Name 24. Signature Printed Name 25. Signature Printed Name 26. Signature Printed Name 27. Signature Printed Name 28. Signature Printed Name 29. Signature Printed Name 30. Signature Printed Name

5 5 NOTICE: ALL CANDIDATES ARE REQUIRED BY LAW TO COMPLY WITH THE PROVISIONS OF THE NJ CAMPAIGN CONTRIBUTIONS & EXPENDITURES REPORTING ACT. FOR FURTHER INFORMATION, PLEASE CAL THE ELECTION LAW ENFORCEMENT COMMISSION AT (609) STATE OF NEW JERSEY} COUNTY OF ATLANTIC} ss:,being duly sworn, upon his oath says that he is a signer of the petition hereto annexed and is a legal voter of, in the State of New Jersey; that the said petition is made in good faith; that the affiant saw all the signatures made thereto; and he/she believes that the signers are duly qualified voters. Subscribed and sworn to before me at,nj, this day of,20 Signature of Signer Notary Public ************************************************** CERTIFICATE OF ACCEPTANCE I, the undersigned, hereby certify that I am a resident of and legal voter in the jurisdiction of the office for which the nomination is made (NJSA 19:13-8). Signature of Candidate ************************************************** OATH OF ALLEGIANCE I,, do sincerely profess and swear that I do and will bear true faith and allegiance to the government established in this state under the authority of the people. So help me, God. Subscribed and sworn to before me at,nj, this day of,20 Signature of Candidate Notary Public