NOMINATION PAPER FOR PARTISAN OFFICE

Paul Knoff
I, the undersigned, request the name of SIGNATURES OF ELECTORS 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. PRINT NAME

Residing at W3765 Granton Road, Granton, WI 54436, in the Town of Grant, be placed on the ballot at the general election to be held November 6, 2012 as a candidate representing the Democratic Party, so that voters will have the opportunity to vote for him for the office of

www.DanAude.com 920-468-9105
Please include your e-mail address if interested in receiving periodic campaign updates.

REPRESENTATIVE TO THE ASSEMBLY - 69TH DISTRICT

STREET & NUMBER OR RURAL ROUTE
Rural addresses must also include box or fire number

I am eligible to vote in the 69th Assembly District. I have not signed the nomination paper of any other candidates for the same office at this election.
THE MUNICIPALITY USED FOR MAILING PURPOSES, WHEN DIFFERENT THAN THE MUNICIPALITY OF RESIDENCE, IS NOT SUFFICIENT, THE NAME OF THE MUNICIPALITY OF RESIDENCE MUST ALWAYS BE LISTED.

CITY, ZIP

MUNICIPALITY OF RESIDENCE
Indicate town, village or city town city village town city village town city village town city village town city village town city village town city village town city village town city village town city village

DATE OF SIGNING ,2012 ,2012 ,2012 ,2012 ,2012 ,2012 ,2012 ,2012 ,2012 ,2012

E-MAIL ADDRESS

PHONE NUMBER

CERTIFICATION OF CIRCULATOR I,
(name of circulator)

, certify: I reside at

(Circulators residence including street, number and municipality)

.
(Circulator E-mail Phone)

I personally circulated this nomination paper and personally obtained each of the signatures on this paper. I know that the signers are electors of the jurisdiction or district that the candidate seeks to represent. I know that each person signed the paper with full knowledge of its content on the date indicated opposite his or her name. I know their respective residences given. I intend to support this candidate. I am aware that falsifying this certification is punishable under s 12.13(3) (a), Wis. Stats.

Return to: Paul Knoff, W3765 Granton Road, Granton, WI 54436 by May 26th, 2012
Authorized and Paid for by Paul Knoff for State Assembly, Lois Hagedorn, Treasurer

,2012
Date Signature of Circulator

Page No.

When Circulating Nomination Papers...

69th Assembly District

1. As a circulator, you will be acknowledging that you personally obtained each signature and that you watched the people who signed the papers you are submitting. Please make sure to the best of your ability that each signer is a district resident. Elector signatures must be legible. If you can't read a name the Government Accountability Board probably won't be able to either. Don't be shy about asking a signer to print his/her name to help verify the signature. The signer must indicate his/her residence, including street number, street and municipality. PO Box and rural route numbers are NOT sufficient. Please check to see that the signer indicates the correct date in the far right-hand box. A person may sign only one nomination paper for each office in an election period. Be sure to ask each person whether he/she has signed another person's nomination paper for the same office, before you accept a signature. When you have completed collecting signatures, please return them to the address listed on the front of this document.

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Thank You. Your help is greatly appreciated!