Board of Election Commissioners For the City of Chicago First Day Filing Ticket No: 019 Do Not Lose This Ticket. This ticket entitles the holder to obtain a 9:00 A.M. filing time on the first day to file petitions for the February 22, 2011 ElectionBOARD OF ELESTION COMMISSIONERS FOR THE GITY OF CHICAGO 9:00 A.M. PETITION FILING nov 15 2010Receipt for Nomination Papers — City of Chicago For the February 22, 2011 Municipal General Election Board of Election Commissioners for the City of Chicago Lance Gough, Executive Director LTT Name of Candidate _ anny t DAVIS Address sqsG W. Race Ave CHO, 12 60644 Office on Petition Alderman — Ward — [X{Mayor City Clerk (City Treasurer Filing Ticket Number Are these items included? (Mark Yes or No) Yes No i xX) sume of Candidacy Receipt for Statement of Economic Interests [eZ] eozaty oath this document is optional.) ‘Are the Nominating Papers bound? : K yes, deseribe how they are bound: Foldloy_ wit ced © Was Election Board photo taken of Nominating Papers? Number on Last Page of Petition _203 Received From x Phonet_123— L3 CAS ¢ Address yhone2 (if available) ‘7 2 35C- LO La mere 2E3O vmait Z Umi A A ——— Signature of person submitting petition ate /[-18-ID For Election Board Employee to Complete Notice of Campaign Finance & Disclosure Requirements Given: In Person. ____By Mail Received By Qa Be “Date WV. LS Jeu ‘Original: Keep with Petition © Copy: For CandidateCOOK COUNTY LER Fee cb STATEMENT OF ECONOMIC INTERESTS. 20-090 axons TO BE FILED WITH THE COOK COUNT¥ICLERK "eSEE Rh" yo HOY 1S JAM 8: 10 Fy CLERK usyeAc omnes TSLorNENT FOR HH MNS TATA 5 : (er, t GENERAL DIRECTIONS EL, L644 The interest (if constructively controlled by the person making the statement) of a spouse or any other party, shall be considered to be the same as the interest of the person making the statement. Campaign receipts shall not be included in this statement, If additional space is needed, please attach supplemental listing. Separate filings for multiple LOCAL offices or positions of employment are not required. You must list the name of each LOCAL unit of government you are required to file for on the top portion of the statement. (Use blue or black ink only.) 1. List the name and instrument of ownership in any entity doing business with a unit of local government in relation to which the person is required to file, in which the ownership interest held by the person at the date of filing is in excess of $5,000 fair market value or from which dividends in excess of $1,200 were received during the preceding calendar year. (In the case of real estate, location thereof shall be listed by street address, or if none, then by legal description.) No time or demand deposit in a financial institution, nor any debt instrument shall be listed. NSTRUMENT OF POSITION OF meen pes EY OWNERSHIP MANAGEMENT Be 2. List the name, address and type of practice of any professional organization in which the person making the statement was an officer, director, associate, partner or proprietor ot served in any advisory capacity, from which income in excess of $1,200 was derived during the preceding calendar year. NAME ADDRESS TYPE OF PRACTICE 3. List the nature of professional services rendered (other than to the unite gre RO MOMOOMANSS' ONE Son to Which the person is required to fle) and the nature of the entity to which ROA Mee rendered iffees exceeding $5,000 were received during the preceding calendar year from the entty for profSdpq@) services tendered by the person making the statement. (Professional services” means services rendered in the practice of law, accounting, engineering, medicine, Nok hen or clinical psychology.) Noy 45 2070 ———: ‘COOK COUNTY CLERK - For oficial we c:2bik 4. List the identity (including the address or legal description of real estate) of any capital asset from which a capital gain of $5,000 are was ne during the preceding calendar year. 5. List the name of any entity and the nature of the governmental action requested by any entity which has applied to a unit of local government in relation to which the person must file for any license, franchise or permit for annexation, zoning or rezoning of real estate during the preceding calendar year if the ownership interest of the person filing is in excess of $5,000 fair market value at the time of filing or if income or dividends in excess of $1,200 were received by the person filing Wb catitydluring the preceding calendar year. 6. List the name of any entity doing business with a unit of local government in relation to which the person is required to file from which income in excess of $1,200 was derived during the preceding calendar year other than for professional services and the ttle or description of any position held in that entity. No time or demand deposit in a financial institution nor any NOM be listed. OMe 7. List the name of any unit of government which employed the person making the statement during the preceding calendar y other than the unit or units of government in relation to which the person is required to file. S vse of ReOCesentatibs 8. List the name of any entity from which a gift or gifts, or honorarium or honoraria, valued singly or in the aggregate in excess of $500, wayreceived during the preceding calendar year. OWE. VERIFICATION “I declare that this statement of economic interests (including any accompanying schedules and statements) has been examined by me and to the best of my knowledge and belief is a true, correct and complete statement of my economic interests as required by the Illinois Governmental Ethics Act. I understand that the penalty for willfully filing a false or incomplete statement shall be'a fine not to exceed $1,000 or imprisonment in a penal institution other than the penitentiary not to exceed one year, or both fine and imprisonment.” Sign Hore——> | 7k Onno //- [3-10 (SIGNATURE OF PERSON MAKING THE STATEMENT BLUE OR BLACK INK ONLY) ATED1OILCS 5/10-5, 10-5.1 ATTACH TO PETITION. Suggested Revised July, 2007 SBE No. P-1A STATEMENT OF CANDIDACY NONPARTISAN NAME ‘ADDRESS-ZIP CODE | OFFICE CITY, VILLAGE OR .__| SPECIAL DISTRICT Danny K. Davis, 5956 W. Race Ave. | Mayor of Chicago Chicago, IL 60644__| City of Chicago Minois STATE OF ILLINOIS ) dss, County of Cook ) 1, Dany K. Davis being first duly sworn (or affirmed), say that I reside at 5956 W. Race Avenue «in the City of Chicago __ (if unincorporated, list municipality that provides postal service) Zip Code 60644, in the County of Cook, State of Ilino that Lam a qualified voter therein, that Iam a candidate for Election tothe oie of Mayor inthe___City of Chicago Name of Cty, Village of Special Distt to be voted upon atthe election to beheld on February 22,2011 (date of election) and that {am legally qualified 10 hold such office and that Ihave filed (or I will ile before the close ofthe petition filing period) a Statement of eonomic Inerests as required by the Ilinois Governmental Ethics Act and I hereby request that my name be Printed upon the official ballot for Election to such office. ‘of Candidate) Signed and sworn to (or affirmed) by Danny K. Davis before me, on November 14, 20) (Name of Candidate) (insert month, day, year) (SEAL) (Notary Public’s Signature) _—— TUMA Rowen OPriCiat SER lotary Publi, State of hina My Commission Expires a amarar ai os oovy SSEAWOLSSUNWUS NG aw wereGOARD OF ELECTION COMI! Poe FOR THE Cit So 9:00 AM FETE Nov 15 2010 FF ISSIONERS Ice?ATTACH TO PETITION. 10 LCS 5/7-10.1 Suggested Revised July, 2004 ‘SBE No. P-IC LOYALTY OATH (OPTIONAL) United States of America ) ss, State of Hlinois ) 1, Danny K. Davis. . do swear (or affirm) that I am a citizen of the United States and the State of Hlnois, that Iam not affiliated directly or indirectly with any communist, organization or any communist front organization, or any foreign political agency, party, organization or government which advocates the overthrow of constitutional government by fore or other means not permitted under the Constitution ofthe United States o the Constitution ofthis tate; that Ido not diretly or indirectly teach or advocate the overthrow of the government ofthe United States or of this State or any unlawful change in the form of the governments thereof by force or any unlawful means, Signed and sworn to (or affirmed) by anny K. Davis. before me, (Name of Candidate) ol ‘on November 14, 2010. (insert mont, day, year) (Notary Public's Signature) TUMIA ROMERO OFFICIAL SEAL Notary Publ, State a linois| My Commiasion Exoiras ‘September 14,2013 (SEAL)Nov 15 2010 ——