4th Rep Longo Petition .pdf

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Original filename: 4th Rep - Longo Petition.pdf
Title: REPRESENTATIVE IN CONGRESS
Author: diane lucia

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REPRESENTATIVE IN THE GENERAL ASSEMBLY
PRIMARY PETITION
We, the undersigned, members of and affiliated with the Republican Party and qualified primary electors of the
Republican Party, in the 4th Representative District of the State of Illinois, do hereby petition that Anthony Longo, who
resides at 1404 W. Erie St, in the City of Chicago, 60642, County of Cook and State of Illinois, shall be a candidate of the
Republican Party for the nomination for the office of REPRESENTATIVE IN THE GENERAL ASSEMBLY of the State of
Illinois, for the 4th Representative District to be voted for at the Primary Election to be held on March 18, 2014.
CITY

COUNTY

1.

Chicago

Cook, IL

2.

Chicago

Cook, IL

3.

Chicago

Cook, IL

4.

Chicago

Cook, IL

5.

Chicago

Cook, IL

6.

Chicago

Cook, IL

7.

Chicago

Cook, IL

8.

Chicago

Cook, IL

9.

Chicago

Cook, IL

10.

Chicago

Cook, IL

NAME
(SIGNATURE)

NAME
(PRINTED)

STREET ADDRESS
(WITH APARTMENT #)

State of Illinois )
) SS.
County of Cook )
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 _________________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)
(SEAL)
______________________________________
(Notary Public’s Signature)
SHEET NO. _______


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