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CANDIDATE S
AFFIDAVIT
PENNSYLVANIA DEPARTMENT OF STATE
BUREAU OF ELECTIONS 210 North Office Building Harrisburg PA 17120
Filer ID
2012C0011
3
Type of Print Firmly in Ink
Name:
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alRACIC
Last Name irst name
Middle Name or Initial
uffix
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Street Address
State:
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Zip
Code:00-
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Municipality: City, Boro, or Township:
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ailing Address (if different from residential):
Residential Address:
til1/4.114
City:
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Street Address
State:
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Zip
Code/1;2.2.7.—
Voting Precinct Name (Including Ward & Division, If applicable):
Office which you are seeking nomination:
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Number (if applicable): E-mail Address:
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C NDID TE FFID VIT
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.
Sworn to and subscribed before me this
swear (or affirm) to the above part(s) as required by the law(s) applicable to the office I am seeking.
ay of 0
Signature of Candidate
Signature of Officer Administering Affirmation Telephone Number
Official Title
My commission expires
County of Residence
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OFFICE USE ONLY
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COUNTY CODE: II
MOUNT RECEIVED:
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OFFICE
ISTRICT OLITICAL
UMBER OF
ELEGATE
PARTY
ETITIONS
TATUS
COMMENTS: CHECKER INPUT
VERIFY
White - Petition Copy
ellow - Data Entry Copy
ink - Accounting Copy
olden Rod - Candidate Copy
Copy provided courtesy of: www.ProtectOurLiberty.org
 
2012C,i a2CI
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Name _,
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GE
CANDIDATE'S AFFIDAVIT
PENNSYLVANIA DEPARTMENT OF STATE BUREAU OF
ELECTIONS
210 North Office Eiiiitting Nerrisburg, PA 17120
*ado Norma
Residential Address;
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27566.-
Municipality:
City. Barn,
or Towne/4D
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Mailing MCIreSS (It dIfiefent fromresideritiall•
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Wang Precinct Name. (InCluding Ward
Uiv,Ffon,
tf
Mire which you ere seeking rominatvn:
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ai
Address:
District Number of
4031iCabie):
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
eleChOrt law or any law regulating and NmetIng nomination and election expenses. and prohibiting corrupt practices ni ccr,naction
If. ir
e
with
 
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 rima 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 t
o aro
i
ro
i
f
,
the
same
year as the office subject to this affidavit.
swear for
affirm)
to the above
oorti.”
aK required by
the
taw{Ft.apoItcat
trjto the
office I am seeking
_fatti*e
OFFICE USE ONLY
COUNTY CODE' ,.,„1 j
MOUNTZECEIVED: S
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ETITIONS
TATUS
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ClitECKER
 
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White - Petition Cr.inY
Yeihnv - Data Entre Cady Mnic .artamoun,rt Copy
Candidate Copy
PA EIGNIFAONINEAL:TH
CA3010.135 Ate. ND
EX44/1
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Copy provided courtesy of: www.ProtectOurLiberty.org
 
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CANDIDATE'S
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PENNSYLVANIA.DEPARTMENT OF
STATE
BUREAU OF
agencoNs
210 Werth Office: Ihrilding
Harrisbonii PA 17120
Type of Pratt
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municipality Cay, Sort, or Township:
Mailing Address (if different
from residennely
Gender. 1- 1,j tt,4
C.ty•
tate: 7
44
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ode 4 4f
vorirtg
precinct
Name irk: fading Ward a tbviieOft, if applicahl4
eel 11 41i
 
wrii,:t you
arcs
s 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)
t
R
:,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 ama
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 Oetegates Stwerreorit was affixed to
dactl
page cif
ray, norm:viten
petition prirar tc
.....ircoaVors of
seOta; that I
am not a candidate
tot an oftice which t
already
No turn or
year
is not set io
expire
ri
rne carnet year
its the Otos subieet to tttio>a
affidavit:
Sworn is and
$11trstribed berme me this
,„, day of ../7.4;12..
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I swear
ior
alfiirro to the above pants)
as
required
 
by ine lawns) applicable to the f am
eierskinit.
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My commission of
 
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441,500- a*
June
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AMOUNT REV_IVED: 5 at:.
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EXHIBIT 22
17A\13efn
Yellow •
Data
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Copy provided courtesy of: www.ProtectOurLiberty.org
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