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Name of Candidate Petition of Candidacy State of Idaho County of Bingham ss. City of Blackfoot PETITION OF CANDIDACY OF FOR OFFICE OF COUNCILMEMBER This petition must be filed in the office of the City Clerk not earlier than 8:00 a.m. on the eleventh Monday nor later than 5:00 p.m. on the ninth Friday immediately preceding election day. The submitted petition must have affixed thereto the names of at least five qualified electors who reside within the appropriate city. I, the undersigned, being a qualified elector of the City of Blackfoot, in the State of Idaho, do hereby certify and declare that I reside at the place set opposite my name and that I do hereby join in the petition of a candidate for the office of Councilmember to be voted at the election to be held on the 5th day of November, 2019. Signature of Petitioner Printed Name Residence Address Date Signed STATE OF IDAHO County of I, being first duly sworn, say: That I am a resident of the State of Idaho and at least eighteen (18) years of age; that every person who signed this sheet of the foregoing petition signed his or her name thereto in my presence; I believe that each has stated his or her name and residence address correctly, and that each signer is a qualified elector of the State of Idaho, and the City of Signed Address Subscribed and sworn to before me this day of Signed Notary Public Residing at Commission expires (Notary Seal) Signature Collector Address of Signature Collector