Democratic Request Form for Watcher Certificates

Instructions are on the following page. 1 Name and phone number of person submitting request to MCDC: 2 Name of person picking up the completed request: 3 Phone number for the person picking up the request: 4 Date of request: 5 ____________________________ 6 7 Township / Borough (not mailing address) Jill Ross Stein, 610-724-1099 Jill Ross Stein 610-724-1099

Please Print

Name of Watcher

Complete Mailing Address

Ward & Precinct

9 I am a candidate for the office of: __________________________________________________ Candidate's Political Party: 10 Candidate's Printed Name: 11 Candidate's Signature: 12 Candidate's Home Address: DEMOCRAT __________________________________________________ Signature on File __________________________________________________

Please feel free to e-mail or fax form to MCDC if the candidates signature is on file.

Watcher Certificate Request Form Instruction Guide for a General Election

610-272-2000 / 610-272-2005 (fax) / info@mcdems.org (e-mail) / www.mcdems.org (web site)
Please reference the numbers above on the form: PLEASE SUBMIT YOUR REQUESTS TO THE MONTGOMERY COUNTY DEMOCRATIC COMMITTEE (MCDC) and not the Board of Elections to avoid having duplicate names submitted. All current committee people at the time in which the certificates are created will automatically receive a watcher certificate. Please use this form to request additional certificates for non-committee people.
Field #

1. 2.

Please print or type the name and telephone number of the person submitting the request form to MCDC. Please print or type the name of the person who is expected to pick up the completed request from the Montgomery County Board of Elections. The Board of Elections can be contacted at: (610) 278-3275. Most often the MCDC staff will retrieve the Certificates for you. Please print or type the telephone number for the person who is expected to pick up the completed request from the Montgomery County Board of Elections. (example: MCDC, 610-272-2000) Please print or type the date that you have submitted this request to MCDC. Please print or type the name of the person who will be watching at the polls. Please use their name as displayed on the voter registration roles. Please print or type the mailing address of the watcher. You must use the mailing address at which the person is registered to vote in Montgomery County. Please print or type the municipality in which the person will be watching (township or borough). That does not mean that they must be watching in the municipality in which they live. It must say, i.e. Hatfield Township or Norristown Borough. It is not the mailing address. The Certificates are valid and accepted at any polling place in Montgomery County. So even if their certificate has them watching the polls in another precinct or municipality, their certificate is still valid at any polling place in Montgomery County.

3. 4. 5. 6. 7.

8.

Please print or type the ward and precinct in which the person will be watching in the municipality that was written in field number 7. (i.e. 2-2 or ward 4). This does not have to be the ward and precinct in which they live. Some municipalities do not have precincts; in that case just list the ward.

Each candidate is allowed 2 watcher certificates at each polling place within their district. 9. 10. 11. Please print or type the candidates office for which he or she is running. (i.e. U.S. Senate, Governor) Please print or type the candidates name. (i.e. Mike Gerber or Josh Shapiro) Requires original signature of candidate listed in field numbers 9 and 10. MCDC may have this signature on file at the Board of Elections, which we can use in place of the original signature. Please call MCDC to verify, and indicate: Signature on-file. Please print or type the candidates home address listed on their filing petitions. If you need help identifying the candidates home address for the use of this form, please call (610) 272-2000.

12.

Democratic Request Form for Watcher Certificates

Instructions are on the following page. 1 Name and phone number of person submitting request to MCDC: 2 Name of person picking up the completed request: 3 Phone number for the person picking up the request: 4 Date of request: 5 October 30 , 2006 6 7 Township / Borough (not mailing address) Hatfield Township Ambler Borough Lansdale Borough
th

Please Print

John Smith; 610-272-2000 Sally Fields 610-272-1279

Name of Watcher Robert Redford Dustin Hoffman Bruce Springsteen

Complete Mailing Address 1515 Democratic Victory Drive 1014 Giant Victory Drive 897 Democratic Majority Street

Ward & Precinct Ward 4 Ward 2 2-2

9 I am a candidate for the office of: Representative in Congress Candidate's Political Party: 10 Candidate's Printed Name: 11 Candidate's Signature: 12 Candidate's Home Address: DEMOCRAT Allyson Schwartz Signature on-file 1510 Fake Address Drive, Jenkintown, PA 19046