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Form 1

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I, .............., being first duly sworn, state that I reside at .............

Street, City of ............................, County and State aforesaid; that I am a qualified elector of said city and the ward in which I reside; that I am a candidate for nomination to the office of , to be (Mayor) (Director) voted upon at the primary election to be held on the .......... day of .........., 20......, and I hereby request that my name be placed upon the official primary election ballot for nomination by such primary election for such office and I herewith deposit the sum of ten dollars ($10.00), the fee prescribed by law.”;

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