CANDIDATE'S STATEMENT FOR THE MARION COUNTY VOTERS' PAMPHLET

NAME OF CANDIDATE
DISTRICT/CITY
OFFICE & POSITION NUMBER


PART ONE: REQUIRED INFORMATION

Occupation (Present employment - may be paid or unpaid)

Occupation Background (Previous employment - may be paid or unpaid)

Educational Background (Schools attended; last grade completed; degree(s), if any)

Governmental Experience (Elected or appointed)

By signing this form I HEREBY CERTIFY THAT all information supplied by me about my occupation, educational and occupational background, and prior governmental experience is true to the best of my knowledge.


X ________________________________________________________ Date:__________________
Candidate Signature

PART TWO: Optional Information


     Word count includes the 7 "Title Header" words in Part One.
 
Name of Person responsible for Part Two content.




X

Signature of Candidate or Person Repsonsible for the content of PART TWO of the Candidate's Statement and completed Word Count.
 


 Amount Paid:______________
 


 Receipt # ______________
 


 Cash ___  Check # ______
 


 Photos:   Yes        No
 


 Staff Initials_______________
Date Stamp