STATE OF ALASKA - DIVISION OF ELECTIONS

DECLARATION OF CANDIDACY
COASTAL RESOURCE SERVICE AREA BOARD MEMBER
ELECTION DATE: OCTOBER 6, 2009

GENERAL INSTRUCTIONS:

  1. Who May File: If you are registered to vote within the boundaries of the Coastal Resource Service Area (CRSA), you may file for the office of CRSA board member. You must also be registered to vote within the section of the seat for which you are filing.

  2. When To File: You may file now, the sooner the better. Hand delivered and faxed candidacy filings must be received no later than 5:00 pm, Friday, August 7, 2009. Mailed forms must be postmarked no later than August 7, 2009, and received by the Division of Elections no later than August 17, 2009.

  3. How and Where To File: Print this page and complete the candidate information below, sign and date the certification, and hand-deliver, mail or fax it to any Division of Elections office (addresses below).
CANDIDATE INFORMATION:
Please Print Clearly or Type Your Information

I, ____________________________________, request that my name be placed on the ballot for the election on

October 6, 2009, for the following CRSA board seat: ______________________________________, Seat ___________

My RESIDENCE address is: _________________________________________________________, Alaska _________

My MAILING address is: ___________________________________________________________, Alaska _________
Telephone: (Home)_________________; (Work)_________________; (Message)__________________

I request my name be placed on the ballot as follows:

Last Name:_________________________________, First Name:________________________________ M.I._______

Nickname and/or Suffix:_________________
* The Director of Elections may not include on the ballot as part of the candidate's name, any honorary or assumed title or prefix but may include in the cadidate's name any nickname or familiar form of a proper name of the candidate. [AS 15.15.030(4)]

Mailing address and phone number to be displayed on the Division of Elections' web site listing:

Official Candidate Mailing Address:____________________________, City:________________________

State:_______ Zip:_____________ Phone_________________


OATH: I certify that the information on this form is true and correct, that I am a registered voter in the State of Alaska and that I reside within the boundary and section of the CRSA board seat for which I am seeking election.

SIGNATURE:_________________________________________ DATE:______________________

VOTER # SSN or ADL#:______________________

Mail or Fax your completed filing to the regional elections office nearest you:

Director's Office
PO Box 110017
Juneau AK 99811-0017
Phone: (907) 465-4611
Fax: (907) 465-3203

Region I Elections Office
PO Box 110018,
Juneau, AK 99811-0018
Phone: (907) 465-3021
Fax: (907) 465-2289

Region III Elections Office
675 7th Ave., Suite H3
Fairbanks, AK 99701-4594
Phone: (907) 451-2835
Fax: (907) 451-2832

Region IV Elections Office
PO Box 577,
Nome, AK 99762-0577
Phone: (907) 443-5285
Fax: (907) 443-2973