HomeMy WebLinkAboutNomination Application - KellyAPPLICATION FOR NOMINATION PAPERS -- CITIES
ELECTION DATE: November 5, 2024
TO BE COMPLETED BY CANDIDATE
NAME AS REGISTERED 1'E
RESIDENCE A DRESS INCLUDING CITY AND ZIP
SC-rn e
MAILING ADDRESS IF DIFFERENT FROM RESIDENCE
E-Mail Address: Fax: ( )
TELEPHONE NUMBER(S): Day (`��(}) � —� Eve.
Palm Desert City Council
OFFICE SOUGHT
OFFICE USE
Registration checked by: za;oAB(Ixe, 4�)Zwjoq
(CLERK AT ROV OFFICE)
Precinct Number:
Full Term ❑ Short Term
District C
DISTRICTIWARD (If applicable)
(951) 486-7200 or 800-773-8683
Date Of Registration:
Material issued by: 4V,% ,d C&&
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To the best of my knowledge, I meet the eligibility requirements for the office I seek. At my request the nomination
documents listed above have been issued to me and I am aware that they must be filed with the City Clerk, during
normal business hours no later than August 9, 2024, at 5 p.m.
STATE LAW REQUIRES CANDIDATE INFORMATION BE A MATTER OF PUBLIC RECORD.
Please indicate if you give permission for your home address and telephone number to be listed on the Internet.
[X Yes
❑ No (If NCB you may provi a mailing address):
IGNATUR
NOTE. A Spanish version of the required forms is available upon request.
La version en espariol de !as formas requeridas estAn disponibles al soliritarlas
DATof SIGN G