PLEASE BE AWARE THAT THIS QUESTIONNAIRE WILL BE PUBLISHED.

The News-Herald

Date questionnaire completed:

Election Questionnaire

Office sought:

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Political party:
Name:

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Female (circle one)

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Age:

Home address:

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Marital status:

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Length of residence in that community:

Occupation:

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Employer: _-

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Public office experience:

Political office held

Municipality

Years served

Elected or appointed?

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High School

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Degree-Subject or Certificate

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(Note: Only list schools from which you've graduated and/or earned degrees, Please indicate if currently attendlng.)
(Note: If you've completed a certificate program, please list in "Other" row and indicate certificate obtained.)

Whether for past pccornpllshments

or future goals, why should voters elect you712..

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