Form 48517 - Allen County / Vanderburgh County Superior Court Judge Declaration Of Candidacy - Indiana Election Commission

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(CAN-41)

ALLEN COUNTY / VANDERBURGH COUNTY

Reset Form

SUPERIOR COURT JUDGE

DECLARATION OF CANDIDACY

State Form 48517 (R5 / 10-07)

Indiana Election Commission (IC 33-33-2-8; IC 33-33-82-31)

INSTRUCTIONS: This form is used by an individual who is seeking election to the superior court in Allen or Vanderburgh County. A declaration of

candidacy must be filed with the Indiana Election Division no later than NOON, February 22, 2008, and no earlier than January 23, 2008. Please print or type all

information on this form except all signatures. SEE IMPORTANT INFORMATION ON BACK OF FORM.

STATE OF INDIANA

COUNTY OF

ALLEN (check one)

VANDERBURGH

GENERAL INFORMATION

I, __________________________________________________________________________ the undersigned, certify the following:

Name of Candidate

(1) I am a registered voter of Precinct _____________________ of the Township of _______________________________________,

(or of Ward _____________ of the City or Town of ______________________), County of _____________________, State of Indiana.

(2) I request that my name be placed on the official general election ballot for the office of

(check one box)

Allen

Vanderburgh County Superior Court Division _______________________________________________________

or the

with the following individual currently serving as incumbent judge ______________________________________________________

to be voted on at the general election to be held on November 4, 2008.

(3) I comply with all requirements under the laws of the State of Indiana to be a candidate for this office (including any applicable residency

requirement). I am not ineligible to be a candidate due to a criminal conviction that would prohibit me from serving in this office.

RESIDENCY INFORMATION

(4) My complete residence address is:

____________________________________________________ _____________________________, Indiana _________________

Complete Residence Address Must Be Inserted

City

ZIP Code

(5) My mailing address is (if different from residence address):

____________________________________________________ _____________________________, Indiana ___________________

Mailing Address

City

ZIP Code

(Write “SAME” if both addresses are identical or leave blank)

CANDIDATE NAME INFORMATION

I request that my name appear on the general election ballot in the following manner:

____________________________________________________________________________________________________________

(*Include any Nickname and/or Suffix, Jr. Sr. II III IV)

I also request that my name on my voter registration record be the same as the name on this declaration of candidacy, and that a copy

of this form be forwarded to the county voter registration office for any necessary change.

The candidate’s name must comply with the requirements in Indiana Code 3-5-7. If a candidate’s name does not comply with this state law, the declaration may be challenged

under Indiana Code 3-8-1-2.

*A candidate may use a nickname on the ballot only if the nickname is a name by which the candidate is commonly known and does not exceed 20 characters.

EXAMPLE: John R. (Jack) Doe A candidate may not use a title or degree as a designation or a designation that implies a title or degree.

CERTIFICATION

I, the undersigned, certify that the information in this Declaration of Candidacy is true and complete, and I meet the specific requirements of this office.

_____________________________________ ______/_____/_______ (_________)______________ (________)_______ _______

Signature

Date signed

Telephone (Day)

Telephone (Evening)

(MM/DD/YY)

↓ Please complete reverse of form ↓