DECLARATION FOR NOMINATION
MUNICIPAL NONPARTISAN OFFICE
13-14-112, MCA

To the Election Administrator of the County of       Cascade      , State of Montana, and to the Electors of the city of       Great Falls      , State of Montana:

I, the undersigned citizen of the United States of America and resident of the City stated herein in the said county, declare pursuant to Section 13-14-112, Montana Code Annotated, that I am a candidate for the election for the office of ______________________________ in the said city at the election to be held ____________________, 20_____, and for such purpose do affirm that I possess, the qualifications prescribed by the Constitution and laws of Montana for the office herein named, and that:

1.My name as it is to appear on the ballot is:______________________________________

2.My mailing address is:_____________________________________________________

3.City, State and Zip Code____________Phone: Home__________Work__________

4.I submit herewith the statutory filing fee of $____________________.

Candidate must sign and acknowledge his/her Declaration for Nomination before a Notary Public is mailed, or before the Election Administrator or Deputy if delivered in person.

On this __________day of_______________, 20_____, before me, personally appeared the above named candidate, known to me or proved to me to be the person whose name is subscribed to the above declaration, and acknowledged to me that he/she executed the same.

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