APPLICATION FOR ELECTION FOR SENIOR CITIZEN SERVE DISTRICT TRUSTEE
I, the undersigned, certify that I was born on ...., (year); and that I have been a resident of the State of Wyoming since ....; that I am a registered voter of the .... senior citizen service district and I do hereby request that my name, ...., be printed on the ballot of the election to be held on the ....day of ...., (year), as a candidate for the office of .... for a term of four (4) years. I hereby declare that if I am elected, I will qualify for the office.
Dated: ....
....(Signature of Candidate)
....(Residence Address)
W.S. 18-15-106