Form M-Qc - Military Qualifying Certification
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1MILITARY QUALIFYING CERTIFICATION
Pursuant to La. R.S. 18:463(A)(1)(d), I am qualifying as a candidate for election to the
office of __________________________________ in the primary election to be held on
(Title of Office)
_____________________________, 20_____ and I am not paying any qualifying fees or
(Election Date)
any additional fee. I hereby certify that I am serving in the armed forces of the United
States, I am stationed or deployed outside of the United States and I am eligible to
become a candidate pursuant to United States Department of Defense Directive 1344.10.
__________________________________
Signature of Candidate
__________________________________
Printed Name of Candidate
Date:______________________________
WITNESSES:
________________________________
_________________________________
_______________________________
_________________________________
Printed Name
Printed Name
Prepared and Furnished by Secretary of State
Military Qualifying Cert. (M-QC) Created 10/12
Approved by Attorney General
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