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DCDSC Notification & Declaration of Candidacy For Add-On Members

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This is the DC Democratic State Committee (DCDSC) Notification & Declaration of Candidacy for Add-On Members.

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36 views1 page

DCDSC Notification & Declaration of Candidacy For Add-On Members

Uploaded by

zisrael985
This is the DC Democratic State Committee (DCDSC) Notification & Declaration of Candidacy for Add-On Members.

Copyright:

© All Rights Reserved
Download as PDF, TXT or read online from Scribd
Download as pdf or txt
Download as pdf or txt
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PO Box 50622 Washington, DC 20091

202/714-3368

NOTIFICATION/DECLARATION OF CANDIDACY
ADD-ON MEMBERS
March 2, 2017
Your Name: _____________________________________________________________________________________
Voter Registration Number: ____________________________________

Ward: ________________________

Address: ____________________________________________________

Zip: ___________________________

Day Contact Number: _________________________________________

Ward: _________________________

Email: ______________________________________________________

(Please print how you wish your name to be placed on the ballot. Do not include prefixes or titles please)

NOTE TO CANDIDATE: The top portion of this form must be completed and submitted
by each candidate Not Later than (NLT) 5:00 PM - February 21, 2017
I hereby declare my candidacy for the office named above. I am aware of the qualifications for holding
this office and attest that I meet such qualifications and understand the requirement to submit 100
valid signatures or pay the required $100 filing fee. I also swear or affirm that the information
provided on this form is true to the best of my knowledge and belief.
___________________________________________
Signature of Candidate

Subscribed and sworn to or affirmed before me this ______ day of ____________________ 2012
______________________________________________________________________
District of Columbia Notary or DCDSC Official

Note: This position is within the District of Columbia Government and is subject to all personnel and election rules and

regulations. Any person who shall make any false representations as to his or her qualifications for holding elective office shall upon
conviction be fined not more than $10,000 or be imprisoned not more than five years, or both.

Authorized by the DC Democratic State Committee, Patrick Allen, Treasurer, Anita Bonds, Chairman. Our report is filed with the DC Office of Campaign Finance and the Federal Elections Commission.

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