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HomeMy WebLinkAbout06. Shafland, JefferyOffice of the Minnesota Secretary of State AFFIDAVIT OF CANDIDACY Filing # Cash/Check # Amount $ Instructions All information on this form is available to the public. Information provided will be published on the Secretary of State's vvebsite. If filing for partisan office and not a major party candidate, you must file both an affidavit of candidacy and a nominating petition. (Minn. Stat. 204B.03) Candidate Information Name, Office, and Party Candidate Name (as it will appear on the ballot) J ) e rf l fiuc-/avid Office Sought C ' G Nit/I CA I Political Party or Principle (State or Federal offices only) Name of Incumbent (Judicial seats only) District q Contact Information Required (federal, judicial, county attorney, and county sheriff candidates are exempt) Check box if you do not have an email address I l Phone number '1 99 4 OJ 21 Email (non -government issued) j 6170 f j a , c i l'o ' Address Information Residence Address Required (unless box is checked; federal, judicial, county attorney, and county sheriff candidates are exempt) My residence address is to be classified as private data. I certify a police report has been submitted, an order for protection has been issued, or I have a reasonable fear for my or my family's safety; or my address is otherwise private by Minnesota law. I have attached a separate form listing my residence address. Residence Address 7 - Vie. ' f y City 6h MI6 1Aq� ViJ� Zip 3 lei Campaign Contact Information (Address required if box above is checked) Campaign Address If/�"I %j City c2 Na h© '_au State State M)\ 1 Zip Code Cv ?? 7(1 Campaign Website Affirmation For all offices, I swear (or affirm) that this is my true name or the name by which I am generally known in the community. If filing for a state or local office, I also swear (or affirm) that: • I am eligible to vote in Minnesota; • I have not filed for the same or any other office at the upcoming primary or general election except as authorized by Minn. Stat. 2046.06, subd. 9; • I am, or will be on assuming office, 21 years of age or more; • I will have maintained residence in this district for at least 30 days before the general election; and • If a major political party candidate, I either participated in the party's most recent precinct caucuses or intend to vote for a majority of that party's candidates at the next general election. If filing for one of the following offices, I also swear (or affirm) that I meet the requirements listed below: • United States Senator — I will be an inhabitant of this state when elected and I will be at least 30 years old and a citizen of the United States for not less than nine years on the next January 3rd, or if filled at special election, within 21 days after the election. • United States Representative — I will be an inhabitant of this state when elected and I will be at least 25 years old and a citizen of the United States for not less than seven years on the next January 3rd, or if filled at special election, within 21 days after the election. • Governor or Lieutenant Governor — I will be at least 25 years old on the first Monday of the next January and a resident of Minnesota for not less than one year on election day. I am filing jointly with • Supreme Court Justice, Court of Appeals Judge, District Court Judge, or County Attorney — I am learned in the law and licensed to practice law in Minnesota. My Minnesota attorney license number is and a copy of my license is attached. • Supreme Court Justice, Court of Appeals Judge, or District Court Judge — I will not turn 70 years of age before the first Monday of next January. • State Senator or State Representative — I will have maintained residence in Minnesota not less than one year and in this district for six months on the day of the general or special election. • County Sheriff — I am a licensed peace officer in Minnesota. My Board of Peace Officer Standards and Training license number is and a copy of my license is attached. • School Board Member — I have not been convicted of an offense for which registration is required under Minn. Stat. 243.166. • County, Municipal, Sch9District, or Special District Office — I meet any other qualifications for that office prescribed by law. Candidate Signa Subscribed Nota o r to take and certify acknowledgement Date , 20 Lori J. Hensen NOTARY PUBLIC MINNESOTA My Commission Expiues Jan. 31, 2027 TN`ia /ys"amp Rev. 5/2.024 FFICE OF THE INNESOTA SECRETARY OF TATE 2024 CANDIDATE NAME PRONUNCIATION FOR Candidate's Name (clearly print): Office Filed For (clearly print): J e .F rod Cl mit Type of District (circle one): Federal State Judicial County S&WCD Township School Hospital Park Other District District District District's Name (clearly print): Candidate Name's Pronunciation: )4— Lee- iaF-LG'IL/I Additional Notes: Info of Staff Member ompletin his form: Name and Title: L,Ot, f ° - 'l'� ;e 14 a „Aar V17 %Lf_ Name of Your Jurisdiction: Date completed: Date submitted to County Auditor's Office: Date submitted to ERS Data -Entry Staff Member: Date entered into ERS: Form updated 5/1/2020KJM