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Name, Title Date Time Declaration of Candidacy Candidate: Please print legibly your legal name Candidate: Please print legibly your name as you want it to appear on the ballot I, the undersigned, affirm that I am a qualified elector of the City of Blackfoot, State of Idaho, and that I have resided in the city for at least thirty (30) days. I hereby declare myself to be a candidate for the office of Councilmember for a term of 4 years, to be voted for at the election to be held on the 5th day of November, 2019, and certify that I possess the legal qualifications to fill said office, and that my residence address Subscribed and sworn to before me this of Signed Notary Public in and for the State of Idaho residing at My Commission OFFICIAL USE ONLY CITY CLERK Before accepting this Declaration of Candidacy, the City Clerk (or designee) must verify: This declaration is accompanied by: The attached Petition of Candidacy signed by at least five qualified city electors with the attached verification from the county clerk, OR A nonrefundable filing fee of $40. The City Clerk (or designee) must verify that the person submitting this declaration is a qualified city elector as defined in Idaho Code 50-402(c) and that the residence address provided above matches the address on the individual’s voter registration. This declaration was accepted by on at After the close of the candidate filing period, a copy of this form must be transmitted immediately to the County Clerk to assist in ballot preparation. COUNTY CLERK Upon receipt of this Declaration of Candidacy, stamp the date and time of receipt on the front of this document. This document is to be used for ballot preparation. Candidate’s Signature