Revised May, 2009
SBE No. P-10
GENERAL
PRIMARY PETITION
We, the undersigned, members of and affiliated with the REPUBLICAN PARTY and qualified primary electors of
the REPUBLICAN PARTY in the State of Illinois, do hereby petition that the following named person or persons
shall be a candidate of the REPUBLICAN PARTY in the nomination/election for the office hereinafter specified to
be voted for at the Primary Election to be held on February 2, 2010.
If required pursuant to 10 ILCS 5/7-10.2, 8-8.1 or 10-5.1, complete the following (this information will appear on the ballot)
FORMERLY KNOWN AS _____________________UNTIL NAME CHANGED ON ________________________
(List all names during last 3 years) (List date of each name change)
State of ___ILLINOIS._______ )
) SS.
County of________________ )
I, ____________________________(Circulator's Name) do hereby certify that I reside at ______________________________in the
City/Village/Unincorporated Area (circle one) of____________________if unincorporated, list municipality that provides postal service
(Zip Code) _________, County of _______________, State of ILLINOIS that I am 18 years of age or older, that I am a citizen of the United States,
and that the signatures on this sheet were signed in my presence, not more than 90 days preceding the last day for filing of the petitions and are
genuine and that to the best of my knowledge and belief the persons so signing were at the time of signing the petition qualified voters of the
REPUBLICAN PARTY in the political division in which the candidate is seeking nomination/elective office, and that their respective
residences are correctly stated, as above set forth.
________________________________
(Circulator's Signature)
Signed and sworn to (or affirmed) by ______________________________before me, on_____________________________.
(Name of Circulator) (Insert month, day, year)
________________________________
(Notary Public's Signature)
(SEAL)
SHEET NO.______________
NAME
|
OFFICE
|
ADDRESS
|
Thomas"Tom" Kuna
|
U.S. Senator
|
300 N. Jefferson, # 1
Jerseyville, Illinois
62052-1767
|
|
NAME
(VOTER'S SIGNATURE)
|
STREET ADDRESS OR
RR NUMBER
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CITY,TOWN OR
VILLAGE
|
COUNTY
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1
|
|
IL
|
|
2
|
|
IL
|
|
3
|
|
IL
|
|
4
|
|
IL
|
|
5
|
|
IL
|
|
6
|
|
IL
|
|
7
|
|
IL
|
|
8
|
|
IL
|
|
9
|
|
IL
|
|
10
|
|
IL
|
|
|