Form P-8 - Petition For Nomination And Formation Of A New Political Party
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1X…BIND HERE…X
PETITION FOR NOMINATION AND FORMATION OF A NEW POLITICAL PARTY
We, the undersigned, qualified voters of the State of Illinois, do declare that it is our intention to form a new political party in the State
of Illinois, to be known and designated as the Green Party, and do hereby petition that the following named persons shall be the
candidates for the offices hereinafter specified, to be voted at the General Election to be held on November 4, 2014.
NAME
OFFICE
ADDRESS & ZIP CODE
United States Senator
1448 N. Kedzie Ave., Chicago, IL 60651
Omar N. López
Governor
20605 E. Brink St., Harvard, IL 60033
Scott Summers
Lieutenant Governor
200 East Broadway, Roseville IL 61473
Bobby J. Pritchett Jr.
Attorney General
107 W. 4th St., Belvidere, IL 61008
David F. Black
Secretary of State
4623 N. Missouri Ave., Peoria, IL 61614
Sheldon Schafer
State Comptroller
1235 Euclid Ave., Berwyn, IL 60402
Tim Curtin
State Treasurer
613 S. Lombard Ave., Oak Park, IL 60304
Julie Samuels
Signature of Voter
Printed Name
Voter's Residence Address
City
County, State
IL
1
IL
2
IL
3
IL
4
IL
5
IL
6
IL
7
IL
8
IL
9
IL
10
State of ______________________________________________
)
)
SS.
County of _____________________________________________
)
I,___________________________, do hereby certify that I reside at ___________________________________, in the
City / Town / Village / Unincorporated Area of __________________, Zip Code ___________, County of ____________,
State of _____________, that I am 18 years of age or older, that I am a citizen of the United States, and that the signatures on this
sheet were signed in my presence, not more than 90 days preceding the last day for filing of the petitions, and are genuine, and that
to the best of my knowledge and belief the persons so signing were at the time of signing the petition registered voters of the State of
Illinois, and that their respective addresses are correctly stated, as above set forth.
Signature of Circulator
Signed and sworn to (or affirmed) by _____________________________ before me, on ___________________________.
Signature of Notary Public
Sheet Number _________
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