Copy provided courtesy of: www.ProtectOurLiberty.

org

CANDIDATE'S
AFFIDAVIT

PENNSYLVANIA DEPARTMENT OF STATE
BUREAU OF ELECTIONS 210 North Office Building Harrisburg, PA 17120
Type of Print Firmly in Ink

Filer ID 2012C0011

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Name:

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First name

Residential Address: City:

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Voting Precinct Name (Including Ward & Division, If applicable): Office which you are seeking nomination: E-mail Address:

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CANDIDATE AFFIDAVIT I do swear (or affirm) that my residence, my election district and the title of the office for which
I desire to be a candidate are as specified above, that I am eligible for said office, that I will not knowingly violate any election law or any law regulating and limiting nomination and election expenses, and prohibiting corrupt practices in connection therewith; that I am aware of the provisions of Section 1626 of the Pennsylvania Election Code requiring pre-election and post-election reporting of campaign contributions and expenditures; that unless I am a candidate for Judge of a Court of Common Pleas, the Philadelphia Municipal Court or the Traffic Court of Philadelphia, or the office of school board in a district where that office is elective of the office of magisterial district judge, my name has not been presented as a acandidate by nomination petitions of any other party for the same office; that if I am a candidate for any office of a political party I am a registered and enrolled member of such party; that if I am a candidate for Committed Delegate or Alternate Delegate to the National Convention the name of the candidate to whom I am committed is as indicated on my petition and that my signature on the Delegate's Statement was affixed to each page of my nomination petition prior to circulation of same; that I am not a candidate for an office which I already hold, the term of which is not set to expire in the same year as the office subject to this affidavit.

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I swear (or affirm) to the above part(s) as required by the law(s) applicable to the office I am seeking.

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AMOUNT RECEIVED: $

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CANDIDATE'S AFFIDAVIT

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PENNSYLVANIA DEPARTMENT OF STATE BUREAU OF ELECTIONS 210 North Office Eiiiitting Nerrisburg, PA 17120

2012C,i!a2CI

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rfor of Prim VirnIfy in Irk
Name _, . 444'. P
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Municipality: City. Barn,

Mailing MCIreSS (It dIfiefent from resideritiall• y, Wang Precinct Name. (InCluding Ward & Uiv,Ffon, tf Mire which you ere seeking rominatvn: rnaai

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the same year as the office subject to this affidavit.

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eleChOrt law or any law regulating and NmetIng nomination and election expenses. and prohibiting corrupt practices ni ccr,,naction If.,irewith : that I am awara of the provislorts of Section 1.5Pe of the Ponnaytvania Election Code recoiling preelection and pr..0.0‘eleetiOn reporting of campaign contribirtfone end expenditures; that (inlet* t rim a candidate fOr Judgo el a Court of Common Pleas, the Philadelphia Murecioal Court or the Traffic Court err the office of schooi board in a district where that office is elective of the office at magisterial district judge. toy Iliirfl15 has not been meeented as tt actindidate by nomination pent:ins pt any other pany fax the sans Om & that # I am a candidate tar any ON* or o pc irticai party I am a registered and enrolled member of such party-. ma! H I am a r.tandklate Clomtnttted Dele.gekte o r Alternate Delegate to the National CIXIVP aan the name at the canradate to whom I am cOmrnittart is as indicated on my etriticaand that my aigneture on the Delegate's Statement was attxtxt to as h page of my nomination pwition !Iran to Circulation at same; That I em not a candidate for an office which I aloteo hod, Iho term of which i a not set to aroiro if,

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CANDIDATE AFFIDAVIT I on swear (cr athrml that my residence ; my election district and the title of the office for which I desire to be a candidate ere as speegia(i above, that I ern eligible tdr said office,•that ! will not knowingly violate any

swear for affirm) to the above oorti.” aK required by the taw{Ft.apoItcat rjto the office I am seeking t _fatti*e

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CANDIDATE'S AFFIDAVIT
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PENNSYLVANIA.DEPARTMENT OF STATE

BUREAU OF

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Type of Pratt Nerne:
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fle51deritial Address:
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Zip Code,

Mailing Address (if different from residennely
C.ty•

State: 7744?.....

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is nomonatiGn

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CANDIDATE AFFIDAVIT - I do swag& Or attlithl irtat my fegtutence,.rny eletmon Ostriet and the tine 01 The etftice IQ! Ueslre lo be a candidate are as specified above. that I am attgittia for s.aicl 0Ifita that I will not it Flowingly violate any election faw or, arty law reguiating and lin -dery nomination and a9e4ttort Oxporise$, anti prohibiting corrupt practices trt the,.ewith; that I arn. aware To4 Lt et provisions of SeCii4irt 182,6. or the Penh.syNaeie Elfictipn Cade !aq,u1ring ore-eieetion end puatiAeqecin reporting PI campaign contributions an0 expenditures. that uniess I am etar4date tc Judge 0.oilrt of Common Pleas, the Philacleiptia Municipal Court or the Tieenrr. C.;ou if of Ptiatiartelptrca, rtir nfline tif ettnett) tR:,60,4$ ut a *strict witOrfil treat 01I.O rS etectui, of the office at trtaGtctorial district ;L:,3ge,. my name Pas Ref Men PhaStrlierl as a acendideleby nomination petitions of any other party for she same office', that if I am a candidate 141 any antes c.t opiihr;ei party t ain rogisterod. and onreitpd rrionibor of sueF party; that it 4:,,i-Indiriate for COrnrrut1041 Daiegate Alternate • DelegetR, to Mho National Convention the name of the candidate lc *horn ; am committOCI tea Oa ;sulk:410d are ;ry petition anti Irrat..tny signatory on the Oetegate's Stwerreorit was affixed to dactl page cif ray, norm:viten petition prirar tc !No turn or year is not set io expire !ri .....ircoaVors of seOta; that I am not a candidate tot an oftice which t already rne carnet year its the Otos subieet to tttio>a affidavit:

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municipality Cay, Sort, or Township:

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Copy provided courtesy of: www.ProtectOurLiberty.org
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CANDIDATE'S AFFIDAVIT

PENNSYLVANIA DEPARTMENT' OF STATE

BUREAU OF ELECTIONS 2-10 North Office Building
Harrisburg, PA 17120

20120320?

Name

SmITO RUM,

rirpa taf Print ritnay i i Ina IC41.1/41b 1;;;;;14;;;xx

Pies ,rierit aal Address'. 10'401

A. zip, cO44.2.0“,

MailingAddrcsa (if different hoer fettideeli441):

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City;

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Stara:PA_ 7IP Coder 1

Office which you are seeking nomination, E-mat. Address:

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Sworn to and aubserlbed Won!

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. 1 1(1 day of .

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AMOUNT RECEIVED; $

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CANDIDATE AFFIDAVIT - I do swear for Ohm) that my residence, my eteotion district rind the title al the Office for which I desire to be a I:Atria-fate We Its specified above, that I am ellgibte for said office.. that teal not $(44rtntring!y'viOlikttft any election law or any law regulating and iimiting nomination and election experiaes. and prohibiting corrupt practices in conroction therewith; thef I am ewers of the provisions ,f Section 1.,42f of the Pennsylvania Election Code requiring are etoPtk:n and post.eleCtion repOrtngre Oarnpargn contributions and e•oenditireas; that unless t air a candidate for Judge of a Coot of Cornier Pleas, the Phiiartelphia Municipal Court or the Traffic Crum of Philadelphia, or the office of school boarl in a district where that office is elective of the Ate of magisteilal dalriet judge. my name has not been presented as a acaockiate by nomination petitions of any oiler Marty for the same olltee, that III are a candidate for any office of ti politica! party l am a vgistered and entotied member of such party. that it t am a candidate for Committed DOlegatv of me of are candidate to when! I am committed is as indicetee on my Alternate Detagaio to the National Como eilt gm, tiffixt,d to ertch 1.1age, of toy nothinahor petition Prior tj petition and that my bigneturr vesrch• I already hold. me term of woven its net set to expire i n vicufatton Of same: That I 4rn 110T 8 the same year as the office subjec_

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for affurr.!: to th Dove pert (8) ac rent8h80 by Wilt -plicattle to I seeking.

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