I INSTRUCTIONS ON REVERSE SIDE I

NOMINATING PETITION
(CITY/TOWNSHIP PARTISAN)
, __ 7 , in the County of
(2"""--/ f
7' '.I _.I. ro fC" ..... ,..""... A..-.I..-.I .. " ......... ,.., .. D ....... 1 D"".+,...\
as a candidate of the CY"'-" f->arty tor me otTIce ot (
/) (Title of Office)
to be held on the "/' day of ,20 12.. .
WARNING -A PERSON WHO OWINGLY SIGNS MORE PETITIONS FOR THE
SIGNS A NAME OTHER THAN HIS OR HER OWN IS VIOLATING
, and State of Michigan,
, PH 3: 50
r (City or Township)
, to be voted for at the Primary Election
istrict, if
AME OFFICE THAN THERE ARE PERSONS TO BE ELECTED TO THE OFFICE OR
E PROVISIONS OF THE MICHIGAN ELECTION LAW.
DATE OF SIGNING
Street Address or Rural Route Zip Code Printed Name Signature
Month I Dav I Year "....
-
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6
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8
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12
13
14
15
T
,
R - DO NOT SIGN OR DATE
CERTIFICATE OF CIRCULATOR
The undersigned circulator of the above petition asserts that he or she is qualified to circulate this petition and that each signature on the petition was IL AFTER CIRCULATING PETITION.
signed in his or her presence; and that, to his or her best knowledge and belief, each signature is the genuine signature of the person purporting to sign
OJ ,.20 / e2
the petition, the person signing the petition was at the time of signing a qualified registered elector of the City or Township listed in the heading of the
(Date)
petition, and the elector was qualified to sign the petition.
WARNING - A CIRCULATOR KNOWINGLY MAKING A FALSE STATEMENT IN THE ABOVE
CERTIFICATE, A PERSON NOT A CIRCULATOR WHO SIGNS AS A CIRCULATOR, OR A PERSON WHO
n. SIGNS A NAME OTHER THAN HIS OR HER OWN AS CIRCULATOR IS GUILTY OF A MISDEMEANOR.

_/flr . )
V\ REORDER NO. 401 (50 TO A PAD) REV 12/02
0 e 00
PRINTING SYSTEMS TAYLOR, MI 1-800-95-12345 FORM APPROVED BY DIRECTOR OF ELECTIONS, STATE OF MICHIGAN
168
--
ZttJI
IINSTRUCTIONS ON REVERSE SIDE I
NOMINATING PETITION
(CITY/TOWNSHIP PARTISAN)
We, the undersigned, registered and voters of the Of}

l:::t:iPa4dCAAJ
,in the County of ,and State of Michigan,
ISTRIKE ONEl //_ /2_ _ _ N
nominate , S3fJaJ
of Candidate) (Street Address or Rural Route) or Township)
as a candidate of the Party for the office of to be voted for at theJPnmary Election
f61 (Till' 01 Office) i"",t, ny) N
to be held on the day of ,20 IZ. ' -0
WARNING -A PERSON WHONOWINGLY SIGNS MORE PETITIONS FOR THE SAME OFFICE THAN THERE ARE PERSONS TO BE ELECTED TO OR
SIGNS A NAME OTHER THAN HIS OR HER OWN IS VIOLATING THE PROVISIONS OF THE MICHIGAN ELECTION LAW. u,
OF SIGNING
Printed Name Street Address or Rural Route Zip Code
/\
Month I Dav I Year
-
k -mJ )' / , -=? 1,<)( } V i"'l, ) +- P+-e... IS- II?
2
1 S l3tsl
3
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6
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'-;..:.; ,o/U/,b C/ .-> / .5-- 94<? I ./ ._ t'- .-- ,_ ,1'/ ,L V:--- ' 7
PArI) I (t I J4 A. D. ,I P,SJ -r c..,- tL () 't\ on .n-1 I M Q I.t.f:: (, I' LiR31S 8 11.
t/P, >1 ,.............. bz....1 I /7_
9
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/31 Oct I=s D\Jo.

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7J-V
13
14
T
15
CULATOR - DO NOT SIGN OR DATE
CERTIFICATE OF CIRCULATOR
The undersigned circulator of the above petition asserts that he or she is qualified to circulate this petition and that each signature on the petition was AFTER CIRCULATING PETITION.
signed in his or her presence; and that, to his or her best knowledge and belief, each signature is the genuine signature of the person purporting to sign
;?., z..' / 12
the petition, the person signing the petition was at the time of signing a qualified registered elector of the City or Township listed in the heading of the
(Date)
p""ioo, aod Ih' ,I,do<'" q,.lill'd 10 ,igo Ih' p,IiIiM - _ ....
WARNING - A CIRCULATOR KNOWINGLY MAKING A FALSE STATEMENT IN THE ABOVE (Printed Name of .,.."
CERTIFICATE, A PERSON NOT A CIRCULATOR WHO SIGNS AS A CIRCULATOR, OR A PERSON WHO
SIGNS A NAME OTHER THAN HIS OR HER OWN AS CIRCULATOR IS GUILTY OF A MISDEMEANOR.
,Q 7 /JZ.'
REORDER NO. 401 (50 TO A PAD) REV. 12102
;::'r Code) CD:
PRINTING SYSTEMS' TAYLOR. MI '-80095-12345 FORM APPROVED BY DIRECTOR OF ELECTIONS, STATE OF MICHIGAN
':68
3f{j1
!INSTRUCTIONS ON REVERSE SIDE I NOMINATING PETITION
(CITY/TOWNSHIP PARTISAN)
We, the undersigned, registered and qualified voters of the Of} , in the County of , and State of Michigan,
S-3800 N
nominate a
(Na'1l e of Candidate) (Street Address or Rural Route) Township)
" , of the {e;;FUGI...It!A-0 p,.rty for the office of to be voted for at thelPrimary Election
(Title of Office) (District, if a y) N
to be held on the day of , 20 / Z. . ....
WARNING -A PERSON WHO KNO\'VINGLY SIGNS MORE PETITIONS FOR THE SAME OFFICE THAN THERE ARE PERSONS TO BE ELECTED TO OR
SIGNS A NAME OTHER THAN HIS OR HER OWN IS VIOLATING THE PROVISIONS OF THE MICHIGAN ELECTION LAW. ..'
c.n
Printed Name Street Address or Rural Route
1,1.
-
/
.
L4-Vf :
J ,
}l.f jt fh L. /6/e+luJG d Id5

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6 P. _: /./
3"V..Jl: .. '" -- \\
2(A(Jji
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I
Signature
9/1 - - - I
10
11
12
13
14
15
I
I
IRCULATOR - DO NOT SIGN OR DATE
CERTIFICATE OF CIRCULATOR
The undersigned circulator of the above petition asserts that he or she is qualified to circulate this petition and that each signature on the petition was I TIL AFTER CIRCULATING PETITION.
signed in his or her presence; and that, to his or her best knowledge and belief, each signature is the genuine signature of the person purporting to sign
,'.26 / 12
the petition, the person signing the petition was at the time of signing a qualified registered elector of the City or Township listed in the heading of the
(Date)
petition, and the elector was qualified to sign the petition.

WARNING - A CIRCULATOR KNOWINGLY MAKING A FALSE STATEMENT IN THE ABOVE
CERTIFICATE, A PERSON NOT A CIRCULATOR WHO SIGNS AS A CIRCULATOR, OR A PE;RSON WHO
SIGNS A NAME OTHER THAN HIS OR HER OWN AS CIRCULATOR IS GUILTY OF A !tJ
. /!?.
REORDER 401 (50 TO A PAD) REV. 12/02 Lif. 0 e (;0
PRINTING SYSTEMS' TAYLOR. MI 1-800-95-12345' FORM APPROVED BY DIRECTOR OF ELECTIONS, STATE OF MICHIGAN
'68
,e.
4tb
ll
I INSTRUCTIONS ON REVERSE SIDE I
NOMINATING PETITION
(CITY/TOWNSHIP PARTISAN)
} -
We, the undersigned, registered and qualified voters of the Township of , in the County of /#cJ6Z?;?B , and State of Michigan,
ISTRIKEONEI 7
nominate G48U . ma .:538'00 /!au.rWOCJj) __----''----__
(Name at Candidate) _ ' (Street Address or Rural Route) , , (City or Township) N

as a candidate of the IC-6m-S;<.IC!A;c) Party for the office of /' XI/? to be voted for at the Elfnary Election
t:I:. /7 (Title of Office) (DistftC( if any) /'
to be held on the /)' day of I'1I1S-Us.-r ,20 12.- . J
WARNING -A PERSON WHO Kf'iOWINGLY SIGNS MORE PETITIONS FOR THE SAME OFFICE THAN THERE ARE PERSONS TO BE ELECTED TO THE d)?FICE OR
SIGNS A NAME OTHER THAN HIS OR HER OWN IS VIOLATING THE PROVISIONS OF THE MICHIGAN ELECTION LAW.
CIRCULATOR - DO NOT SIGN OR DATE
CERTIFICATE OF CIRCULATOR
1),,2 0 '+ 021);c;LJ
u(. 20lL
10'1
9
02.1
0
l.i I 21/2-
"183.1 S-
4 8si S
'1;}SI5
ftAP
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WAS W\ (.( AJO
LY/;;.:s;.('Y)UAJJJ
Signature 1 _ Printed Name I Street Address or Rural Route Zip Code
2
9
15
13
14
12
11
10
eJ
2 t)(J; ;2(/)/
The undersigned circulator of the above petition asserts that he or she is qualified to circulate this petition and that each signature on the petition was AFTER CIRCULATING PETITION.
signed in his or her presence; and that, to his or her best knowledge and belief, each signature is the genuine signature of the person purporting to sign
i 10 / IZ-
the petition, the person signing the petition was at the time of signing a qualified registered elector of the City or Township listed in the heading of the
(Date)
petition, and the elector was qualified to sign the petition.
WARNING - A CIRCULATOR KNOWINGLY MAKING A FALSE STATEMENT IN THE ABOVE
" CERTIFICATE, A PERSON NOT A CIRCULATOR WHO SIGNS AS A CIRCULATOR, OR A PERSON WHO
SIGNS A NAME OTHER THAN HIS OR HER OWN AS CIRCULATOR IS GUILTY OF A MISDEMEANOR.
__ /?Yr'
REORDER NO. 401 (50 TO A PAD) REV 12/02 ;::'L Code) (T-Y
PRINTING SYSTEMS' TAYLOR, MI 1-800-95-12345' FORM APPROVED BY DIRECTOR OF ELECTIONS, STATE OF MICHIGAN

vJ'- ,vI ot-e
............
&Ur;-
O..L5e-
KfJ.)-h{ft' n c. MorehtJuSt/

I INSTRUCTIONS ON REVERSE SIDE I
NOMINATING PETITION

(CITY/TOWNSHIP PARTISAN)
We, the undersigned, registered and qualified voters of Of} 'I ' in the County of , and State of Michigan,
jSTRIKE ONEI /
nominate :SSg'en
(Name of Candidate) (Street Address or Rural Route) !;I Township) N
as a candidate of the &;:::tL.84MAJ Party for the office of to be voted for at Election
M (Title of Office) 4lIStrlct, if ny) I
to be held on the 7 day of , 20 / ;? . N
WARNING -A PERSON WHO ,(NOWINGLY SIGNS MORE PETITIONS FOR THE SAME OFFICE THAN THERE ARE PERSONS TO BE ELECTED TO THE OR
SIGNS A NAME OTHER THAN HIS OR HER OWN IS VIOLATING THE PROVISIONS OF THE MICHIGAN ELECTION LAW.
DA
Signature Printed Name Street Address or Rural Route Zip Code
Man
2.0 'z...
01
, - , ,. ............ __ or- "" rll , . [ , I. _ _".1 -
I.i J
4fs3/b
10
-
11
12
13
-
14
-
15
l!lCULATOR - DO NOT SIGN OR DATE
CERTIFICATE OF CIRCULATOR
The undersigned circulator of the above petition asserts that he or she is qualified to circulate this petition and that each signature on the petition was I""rYr CAJ:E JJJ4TIL AFTER CIRCULATING PETITION.
signed in his or her presence; and that, to his or her best knowledge and belief, each signature is the genuine signature of the person purporting to sign
0l,tfU)/'Z
the petition, the person signing the petition was at the time of signing a qualified registered elector of the City or Township listed in the heading of the
(Date)
petition, and the elector was qualified to sign the petition.

WARNING - A CIRCULATOR KNOWINGLY MAKING A FALSE STATEMENT IN THE ABOVE (Printed Name of CK'Eul.e,torL
CERTIFICATE, A PERSON NOT A CIRCULATOR WHO SIGNS AS A CIRCULATOR, OR A PERSON WHO
,J
4
5
3
8
".1 n . ".I 1 ___ II , ,
"
III
_.
II .. -
5/'/&;28t;/ ,h,uL:)
(City or
SIGNS A NAME OTHER THAN HIS OR HER OWN AS CIRCULATOR IS GUILTY OF A MISDEMEANOR.
.
REORDER 401 (50 TO A PAD) REV. 12/02
Complete Residence Address (Street and Number or Rural Roule) ;::'1. Code)
PRINTING SYSTEMS' TAYLOR, MI 1-800-95-12345' FORM APPROVED BY DIRECTOR OF ELECTIONS, STATE OF MICHIGAN OJ
'68
/"
IINSTRUCTIONS ON REVERSE SIDE I
NOMINATING PETITION
(CITY(TOWNSHIP PARTISAN)
'j ,in the County of , and of Michigan,
,.$raJ ,
(Street Address or Rural Route) / '7 (City or Township) :::
. . /.. 72- ..s -= ::::0
as a candidate of the / Party for the office of , k.4, to be voted for at the primary Election
/). (Title of Office) N
to be held on the day ofu>7 ,20 12 . "
WARNING -A PERSON WHO O\VINGLY SIGNS MORE PETITIONS FOR THE SAME OFFICE THAN THERE ARE PERSONS TO BE ELECTED TO THE OR
SIGNS A NAME OTHER THAN HIS OR HER OWN IS VIOLATING THE PROVISIONS OF THE MICHIGAN ELECT!ON LAW. 't!tf
U'I
SIGNING
Month I Dav I Year
IRCULATOR DO NOT SIGN OR bATE
uNTIL AFTER CIRCULATING PETITION.
c:l.. .' /J. / I z..
(Date)
Street Address or Rural Route
_
;::11: Code) CO
168
Printed Name Signature
8
5
9
6
7
3
2
14
13
11
10
12
Q -. - - - -
C;
CERTIFICATE OF"'CIRCULATOR
The undersigned circulator of the above petition asserts that he or she is qualified to circulate this petition and that each signature on the petition was
signed in his or her presence; and that, to his or her best knowledge and belief, each signature is the genuine signature of the person purporting to sign
the petition, the person signing the petition was at the time of signing a qualified registered elector of the City or Township listed in the heading of the
petition, and the elector was qualified to sign the petition.
WARNING - A CIRCULATOR KNOWINGLY MAKING A FALSE STATEMENT IN THE ABOVE
CERTIFICATE, A PERSON NOT A CIRCULATOR WHO SIGNS AS A CIRCULATOR, OR A PERSON WHO
'\. SIGNS A NAME OTHER THAN HIS OR HER OWN AS CIRCULATOR IS GUILTY OF A MISDEMEANOR.
REORDER 401 (50 TO A PAD) REV 12102
PRINTING SYSTEMS' TAYLOR. MI 1-800-95-12345 FORM APPROVED BY DIRECTOR OF ELECTIONS, STATE OF MICHIGAN
1 COli IS
I INSTRUCTIONS ON REVERSE SIDE I
NOMINATING PETITION
(CITY/TOWNSHI P PARTISAN)
} 7 b -N
We, the undersigned, registered and qualified voters of the Township of .s hL J b'/ ' in the County of (VI ('J L-d Vl-\ , and 8!Jte of Michigan,
ISTRIKE ONEI /1. "7:> >
nominate 6J A JL a et9 s.38l1J (2. $' fa . I h ''''-I t" .
(Name Elf Candidate) (Street Address or Rural Route) (City or Township) N
as a candidate of the f2.. e V b1\C. A ,.J Party for the office of --r V ") -t-< -<... 5 h I b 1 -r:.., (J to be voted for at the"'Dimary Election
(Title of Office) (District, if any) :x
to be held on the 7 i:=b day of AV'1 v ,20 I 'L- . 'f!
WARNING -A PERSON WHO KNOWINGLY SIGNS MORE PETITIONS FOR THE SAME OFFICE THAN THERE ARE PERSONS TO BE ELECTED TO THE 6iFICE OR
SIGNS A NAME OTHER THAN HIS OR HER OWN IS VIOLATING THE PROVISIONS OF THE MICHIGAN ELECTION LAW.
Signature Printed Name Street Address or Rural Route Zip Code
-
K.b
CULATOR - DO NOT SIGN OR DATE
AFTER CIRCULATING PETITION.
..... - --- , .. -- .-.-..,
, r
2.4 MIL-c BelJCtF' c moY"VI s:
1-, L.{ M', (e
Orr!
3
I L. 1'1/96 SU/H/11/:..

6
7
-
8
-
9
-
10
-
11
-
12
\L, \\

-
I S- I I
CERTIFICATE OF CIRCULATOR
The undersigned circulator of the above petition asserts that he or she is qualified to circulate this petition and that each signature on the petition was
signed in his or her presence; and that, to his or her best knowledge and belief, each signature is the genuine signature of the person purporting to sign
/ ,/6 j,.2t:)/2
the petition, the person signing the petition was at the time of signing a qualified registered elector of the City or Township listed in the heading of the
IDate)
petition, and the elector was qualified to sign the petition.
WARNING - A CIRCULATOR KNOWINGLY MAKING A FALSE STATEMENT IN THE ABOVE

CERTIFICATE, A PERSON NOT A CIRCULATOR WHO SIGNS AS A CIRCULATOR, OR A PERSON WHO
SIGNS A NAME OTHER THAN HIS OR HER OWN AS CIRCULATOR IS GUILTY OF A MISDEMEANOR.

-9';Y;3/.s-
REORDER NO. 401 (50 TO A PAD) REV 12/02
.:'r Code) (JO'
PRINTING SYSTEMS TAYLOR, MI 18009512345 FORM APPROVED BY DIRECTOR OF ELECTIONS, STATE OF MICHIGAN

0b
1l /5
I INSTRUCTIONS ON REVERSE SIDE I
N,OMINATING PETITION
(CITY/TOWNSHIP PARTISAN)
Oily } __
, in the County of ......... , and State of Michigan,
/1__.
,ttt>
(Street Address or Rural Route) r (City or Township) N
Party for the office of . to be voted for at the Election
(Title of Office) ;;:0
.20 Ie... ,
WARNING -A PERSON WHO OWINGLY SIGNS MORE PETITIONS FOR THE SAME OFFICE THAN THERE ARE PERSONS TO BE ELECTED TO THE O6FICE OR
SIGNS A NAME OTHER THAN HIS OR HER OWN IS VIOLATING THE PROVISIONS OF THE MICHIGAN ELECTION LAW. :z::
ified voters of the Township of
ISTRIKEONEI
nominate VQt?R
... , ,... ,
eruOAl e.fl1I)

to be held on the "/ -. '" day of ST

z-
( 2.-;
j:... I [l Ie)
L V\
L
H

1/ 12..

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PI
f------'
If I

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:> 'I.lJ 7/ /31ue.
Signature
9
2
5
7
6
8
3
15 v J"'c::L N I V3 I -JJ. '1'(0 W{A.lDSf)A
12
14 .... / I .JI3AAJAJnJE I 5bSolS" -St1 ()fl/A OJ?..
13
10
1'1
REORDER NO. 401 (50 TO A PAD) REV. 12/02
PRINTING SYSTEMS TAYLOR, MI 1-800-95-12345 FORM APPROVED BY DIRECTOR OF ELECTIONS, STATE OF MICHIGAN
WARNiNG - A CIRCULATOR KNOWINGLY MAKING A FALSE STATEMENT IN THE ABOVE
CERTIFICATE, A PERSON NOT A CIRCULATOR WHO SIGNS AS A CIRCULATOR, OR A PERSON WHO
SIGNS A NAME OTHER THAN HIS OR HER OWN AS CIRCULATOR IS GUILTY OF A MISDEMEANOR.
CERTIFICATE OF CIRCULATOR
Tl'te undersigned circulator of the above petition asserts that he or she is qualified to circulate this petition and that each signature on the petition was
signed in his or her presence; and that, to his or her best knowledge and belief, each signature is the genuine signature of the person purporting to sign
the petition, the person signing the petition was at the time of signing a qualified registered elector of the City or Township listed in the heading of the
petition, and the elector was qualified to sign the petition.

qetj, /S"
I INSTRUCTIONS ON REVERSE
NOMINATING PETITION
(CITY/TOWNSHIP PARTISAN)
We, the undersigned, registered and qualified voters of Of} 1 'in the County of , and State of Michigan,
nominate ISTRIKEONEI tS38'OO
E. (Name of Candidate) (Street Address or Rural Route) or Township)
. --r- ;::0
as a candidate of the Party for the office of to be voted for at the flrimary Election
t;(. (Title of Office) (Diltrict, if any) N
to be held on the '7 day of ,uS'7 ,20 I Z . . ....
WARNING -A PERSON WHO KNOWINGLY SIGNS MORE PETITIONS FOR THE SAME OFFICE THAN THERE ARE PERSONS TO BE ELECTED TO THE OA=ICE OR
SIGNS A NAME OTHER THAN HIS OR HER OWN IS VIOLATING THE PROVISIONS OF THE MICHIGAN ELECTION LAW. <f1
2
3
4
5
6
7
8
9
10
11
12
f\V 13 I lIu ( >ngp 1(> I 1 '_ """'" I .1 I,
14
15
:s
CIRCULATOR - DO NOT SIGN OR DATE
CERTIFICATE OF CIR'CULATOR
The undersigned circulator of the above petition asserts that he or she is qualified to circulate this petition and that each signature on the petition was 'NTIL AFTER CIRCULATING PETITION.
signed in his or her presence; and that, to his or her best knowledge and belief, each signature is the genuine signature of the person purporting to sign
iiJ-,;;D /I "2
the petition, the person signing the petition was at the time of signing a qualified registered elector of the City or Township listed in the heading of the
- I 7 (Date)
petition, and the elector was qualified to sign the petition.
"E:._ !'<.
. -- f----'

WARNING - A CIRCULATOR KNOWINGLY MAKING A FALSE STATEMENT IN THE ABOVE (Printed Name
CERTIFICATE, A PERSON NOT A CIRCULATOR WHO SIGNS AS A CIRCULATOR, OR A PERSON WHO
SIGNS A NAME OTHER THAN HIS OR HER OWN AS CIRCULATOR IS GUILTY OF A MISDEMEANOR.
1?2t'
REORDER NO. 40 I (50 TO A PAD) REV. 12/02
Complete Residence Address Number 6rRuraoute) ::11" Code) GP
PRINTING SYSTEMS' TAYLOR, MI 1-800-95-12345 FORM APPROVED BY DIRECTOR OF ELECTIONS, STATE OF MICHIGAN
n ,'\
'Od
We, the undersigned, registered and qUglified voters of the Township of


l' L
1"D /s
!INSTRUCTIONS ON REVERSE SIDE I
NOMINATING PETITION
(CITYrrOWNSHI P PARTISAN)
Oily }
,in the County of ,and State of Michigan,
[STRIKE ONEI
/ N
nominate , :57eay $5
(NaiVe of Candidate) --:-- (Street Address or Rural Route) r (City or Township) ;;
as a candidate of the Party for the office of &:;? to be voted for at the ftrlmary Election
(Title of Office) ([f;strict, if any) N
to be held on the '6 day of 1Ja...e,.Us.r ,20 /2. . \iJ
WARNING -A PERSON SIGNS MORE PETITIONS FOR THE SJ\ME OFFICE THAN THERE ARE PERSONS TO BE ELECTED TO THE OR
SIGNS A NAME OTHER THAN HIS OR HER OWN IS VIOLATING THE PROVISIONS OF THE MICHIGAN ELECTION LAW. c;,
DAl'!!'OF SIGNING
Signature Printed Name Street Address or Rural Route Zip Code
I
ts\u
\J

-- . )
/'/. :'c Code a.::-
'6&
1 -J}1@7'D _I Dc I

I __ Jd
IY
12
14
15
9
13
7
6
CERTIFICATE OF CIRCULATOR
The undersigned circulator of the above petition asserts that he or she is qualified to circulate this petition and that each signature on the petition was
signed in his or her presence; and that, to his or her best knowledge and belief, each signature is the genuine signature of the person purporting to sign
the petition, the person signing the petition was at the time 0' signing a qualified registered elector of the City or Township listed in t:1e heading of the
petition, and the elector was qualified to sign the
WARNING - A CIRCULATOR KNOWINGLY MAKING A FALSE STATEMENT IN THE ABOVE
CERTIFICATE, A PERSON NOT A CIRCULATOR WHO SIGNS AS A CIRCULATOR, OR A PERSON WHO
SIGNS A NAME OTHER THAN HIS 1HER OWN AS CIRCULATOR IS GUILTY OF A MISDEMEANOR.
REORDER NO. 401 (50 TO A PAD) REV 12(02
PRINTING SYSTEMS' TAYLOR, MI 1-800-95-12345' FORM PPROVED BY DIRECTOR OF ELECTIONS, STATE OF MICHIGAN
10
11
8
I
Month I Dav I Year
It bfjl
I INSTRUCTIONS ON REVERSE SIDE I
NOMINATING PETITION
(CITY/TOWNSHIP PARTISAN)
alified voters of the Of} _ 'in the County of , and State of Michigan,
@JRrQ@ --- N
, $3800 , Me P ::I:
91 Candidate) __ (Street Address or Rural Route) .---'City or Township)
as a candidate of the Party for the office of , h. to be voted for at the Ftimary Election
/Ja( (ntl,ofQffire) N
to be held on the /' day of ,20 /Z. .
WARNING -A PERSON WHO NOWINGLY SIGNS MORE PETITIONS FOR THE SAME OFFICE THAN THERE ARE PERSONS TO BE ELECTED TO THE QEFICE OR
SIGNS A NAME OTHER THAN HIS OR HER OWN IS VIOLATING THE PROVISIONS OF THE MICHIGAN ELECTION LAW.
./1ignature Printed Name Street Address or Rural Route Zip Code
DATELlF SIGNING
Month I Dav I Year
1 f1I /. 1.1 }ftb J2.It..."I,A1 LAJtlf'JJ ,.. 5 t.t.6 '-I J),b'iJJ,.Jf, AJd e-t'
<.t

2
!" 0II J . . "
-
c!..
&tJ;1fJ
[/83 j '7
L"l
f/S"'3/ '




5
61l11" U' I/o. .-..... j/U;OlQlfr
-

6 FA.



7 7 -- - V" ..
8
9
10
11
12
13
14
15
!
CERTIFICATE OF CIRCULATOR

The undersigned circulator of the above petition asserts that he or she is qualified to circulate this petition and that each signature on the petition was
signed in his or her presence; and that, to his or her best knowledge and belief, each signature is the genuine signature of the person purporting to sign
the petition, the person signing the petition was at the time of signing a qualified registered elector of the City or Township listed in the heading of the
petition, and the elector was qualified to sign the petition.
WARNING - A CIRCULATOR KNOWINGLY MAKING A FALSE STATEMENT IN THE ABOVE (Printed ,

CERTIFICATE, A PERSON NOT A CIRCULATOR WHO SIGNS AS A CIRCULATOR, OR A PERSON WHO
SIGNS A NAME OTHER THAN HIS OR HER OWN AS CIRCULATOR IS GUILTY OF A MISDEMEANOR.
_
REORDER NO. 401 (50 TO A PAD) REV 12/02
:::'r Code)
PRINTING SYSTEMS TAYLOR, MI 1-800-95-12345' FORM APPROVED BY DIRECTOR OF ELECTIONS, STATE OF MICHIGAN

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