DELEGATE TO THE COUNTY CONVENTION - CANDIDATE FILING FORM********************************************************************************************

I, __________________________________ am a registered voter in __________________ County; registered to vote

(Registered voter’s name)

and residing at __________________________________ _______________________ _______________ _____________,

(Street address ) (City) ( State) (Zip)

whose mailing address is: ________________________________________________________________________ and phonenumber to contact me is: _____________________________ or ________________________________, declare that I am acandidate for the office of Delegate to the County Convention, in __________________ County for the _______________ Party,

(Name of County) (Name of Party)

I request that my name _____________________________________________________________ be placed on the official

(Print name as it is to appear on the ballot. - See reverse side for information.)

ballot for the election to be held the 11th day of May, 2010.

State of Nebraska

))ss

County of

_________________ )

I HEREBY SWEAR THAT I WILL ABIDE BY THE LAWS OF THE STATE OF NEBRASKA REGARDING THERESULTS OF THE PRIMARY AND GENERAL ELECTIONS, THAT I AM A REGISTERED VOTER AND QUALIFIED TO BEELECTED, AND THAT I WILL SERVE IF ELECTED.IN WITNESS WHEREOF, I have hereunto subscribed my name this _____________ day of _____________________, _____.

(Day) (Month) (Year)

____________________________________

Signature of Candidate

Subscribed in my presence and sworn to before me this ________ day of ____________________, ________.

(Day) (Month) (Year)

(SEAL) ____________________________________ _____________________________________

Officer Administering Oath

Title

Purpose:

This form may be used to file as a delegate tothe county convention

Filing Deadlines

As a candidate for Delegate to theCounty Convention, this filing must be received by the countyclerk or election commissioner on or before

March 1st

prior to the date of the primary election

Instructions:

Please complete the form in itsentirety, by printing the information requested in thespaces provided. Incomplete forms could delay theeffective date of your filing. Be sure the form is legible. Donot sign the form until you are in front of a notary public. If you have any questions, contact your local ElectionCommissioner, County Clerk or Election Division Staff atthe Secretary of State’s Office.

Optional Box

___________________________ _________________________________________________

(Candidate’s business phone) (Candidate’s business address)

To assist with proper pronunciation of your first and/or last name on the ballot, please provide the phonetic spelling and / or arhymes with word.

[Examples

: Sue Jahn = Sue Hahn (rhymes with fawn)

William Mishaud = mee-SHO (‘d’ is silent)

Tanya Monte = TAWN –yuh (not TAN) mahn TEA

]

______________________________________