STATE OF VERMONT
..................... County
The undersigned hereby petition the town clerk and other town officers of the Town of .........................., County of .........................., Vermont that
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(Name of Candidate -- Nominee)
be a nominee for election to the office of
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(Name of Office)
at the local election to be held in the town on the ................. day of ..........................., 20 ............... . We certify that we are presently voters of that town.
NAME/SIGNATURE STREET ADDRESS
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17 V.S.A. § 2681