Kansas Independent Nomination Petition Ip - Affidavit Of Petition Circulator
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2Kansas Independent Nomination Petition IP
I, the undersigned, an elector of the appropriate election district, county of _______________________________ , state of Kansas, and
a duly registered voter, hereby nominate ________________________________________________ who resides in the township of
_______________________ (or at number ________________ on __________________________________________ street, city of
_________________________________________ ), in the county of _____________________ state of Kansas, as an independent
candidate for the office of _______________________________________ , district # _____________ (if applicable) to be voted for at the
general election on November ______ , 20 _________ ; and I further declare that I intend to support the candidate herein named and that I
have not signed and will not sign any nomination petition for any other person for such office at such general election.
Signature of Signer
Name of Signer (Print)
Street number or rural route
Name of City
Date
(as registered)
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K.S.A. 25-303
Revised 7/2/14 tc
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