PLEASE BE AWARE THAT THIS QUESTIONNAIRE WILL BE PUBLISHED.

The News-Herald

Date questionnaire completed: _CJ.4t'---'/c....:8=1-';;~/....:..I

Election Questionnaire

Office sought:

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Political party:
Name:
Age:

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Home address:

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Length of residence in that community:
Occupation:

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Marital status:

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Campaign Web site:

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Public office experience:
Political office held

Municipality

Years served

Elected or appointed?

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Non-elected experience (committees, boards, etc.):
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Other

(Note: Only list schools from which you've graduated and/or earned degrees. Please'indicate if currently attending.)
(Note: If you've completed a certificate program, please list in "Other" row and indicate certificate obtained.)
Should you be elected, what are three specific areas you'd like to change, address, improve or further research, and how

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Whether for past accomplishments or future goals, why should voters elect you? ;;; S/./w...D
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