“State of Arkansas County of . . . . . . . . . . . . .
I, . . . . . . . . . . . . . ., being first duly sworn, state that I reside at . . . . . . . . . . . . . .; that I am a resident and qualified elector of . . . . . . . . . . . . . . community college district; that I am a candidate for the office of position No. . . . . . . . . . . on the local board of such community college, and I hereby request that my name be placed on the ballot as a candidate for such position at the coming general or annual school election
Subscribed and sworn to before me this . . . . . . . . . . day of . . . . . . . . . . . . . ., 20. . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Notary Public” (Signed) . . . . . . . . . . . . .
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