ELECTIONS CANDIDATE

APPOINTMENT OF POLL WATCHER (OPTIONAL)

PRIMARY ELECTION DEADLINE: MARCH 18, 2022 BY 4:30 P.M.

I, (Print Candidate Name)______________________________, a candidate for the Osage Nation Election

to be held on APRIL 4, 2022 wish to appoint the person named below to serve as a Poll Watcher on my
behalf:

_________________________________ _________________________________
Signature Date

The Poll Watcher must fill out the below section.

_____________________________ _________________
Last Name First Name
_______________________ _______________________ _____________________________________
Main Phone Number Alternate Number E-mail Address
___________________________________ _________________ ___________ ___________ _______
Mailing Address City State County Zip

I, (Print Poll Watcher Name)______________________________, Poll Watcher for the above appointing
authority, understand that Poll Watchers are prohibited from:
 Receiving any compensation for their services;
 Conversing with voters and election officials;
 Having any electronic devices (Devices will be surrendered to the Board until departure. An
emergency contact number will be provided for the Poll Watcher to use for EMERGENCIES ONLY.);
 Returning to the polling place after leaving for any reason; and
 Divulging any information prior to the announcement by the Board.

Poll Watchers are to remain in the areas designated by the Board. Any disruption by the watcher will be
cause for their removal from the polling place.

_________________________________ _________________________________
Poll Watcher Signature Date

FOR ELECTION OFFICE USE ONLY