Statement of Candidacy to

Serve as At Large Member of the Central Committee

Democratic Party of the Commonwealth of Puerto Rico
Name:
Address:
District of Residence:
Phone:
Email:
Occupation:
Date of Birth:

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Signature

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Date

Democratic Party Commonwealth of Puerto Rico

Attention to: Tatiana Alejandro Souffront, Esq.
Executive Director
1509 Lpez Landrn Street, 10th Floor, American Airlines Building
San Juan, Puerto Rico 00911