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1 Declaration of Candidacy County Commissioner, County Clerk, County, County Assessor, County Coroner REC~i- ED MAR O c,,.,,,j._ IC ; JO C,. ""'. V I. I Filing Dates Candidate Filing Candidate Withdrawal First Day to File Last Day to File Office Information February 26, 2018 Primary: March 23, 2018 March 9, 2018 by 5:00 PM in the County Clerk's Office General: September 7, 2018 Filing for the Office of: f 17 fll/1''' c/4, ~~lr\iss11j,1en- b/si. I Party Affiliation: C.. I onstitution D Democratic D Libertarian JZ1. Republican Candidate Information Candidate Name (As it appears on your voter registration record) First MI Las~ lr;tj/1/ar}j /?1, Be Residence Address (As it appears on your voter registration record) Street Address City State L,ip Code ~nty v :2 7 ;;l. W,.,:2&,0 ~, Burt~ J:J\ >] 33 (J> 45$7~ Mailing Address / Street Address City State Zip Code County ~ 7;J.. W, d-00 SJ, t5lvd¼ 22) v~1; CtrssJ~ How you would like your name to appear on the ballot: L;; tt:p A/ A f!.1' tj". Ke-d- Suffix Campaign Finance Information Have you updated or filed a C1: Appointment and Ceitification of Political?!Sa Yes D No Contact the County Clerk for campaign finance filing information. I Certification I, the undersigned, being a resident of the State of Idaho and of the County listed above, and registered with the party selected, do hereby declare myself a candidate for the office entered above to be voted on at the Primary Election to be held on the 15th day of May, 2018 and I certify that the information on this Declaration is true and accurate. I fmther ce1tify that I possess the legal qualifications to hold said office. I submit herewith the statutory filing fee of $, or in lieu of the filing fee, nominating petitions containing the statutoiy number of signatures of qualified electors. ~,I~ Dated:.J~/,,. 20 IY Candidate Signatur~ --/llj ~~--- - Subscribed and sworn to before me this._\- day of lfu i l t\ ' lo l f. Signature: ~~ Notary Publfuinand for the State of Idaho, residing at (Notary Seal) 13utlt~ My Commission Expires: I / IL/ ZO 2 '1 I EC-10 - Declaration of Candidacy for County Offices - Approved by the Secreta1y of State, December 2017,,,1111,,,,,''\~t:.L BE-.A! 1,,,, t i,.,,..,.,,' ~.... '-A.,,, '...., ~ :: :...,otan1_\ -:...,..., r, r - : :. - - ~-~ ~.-. n \t.:,ubl\g / ::.- v.1.,, 0..., 1-;,,.;,.... ~~,'.,.,.., )', t>-'~ ' ' 11 1 ~ OF \Q,,,' '''''"'''''

2 Petition for Candidacy County Commissioner, County Clerk, County, County Assessor, County Coroner I Filing Dates & Information r;_c.ceived MAk O First Day to File February 26, 2018 Last Day to File March 9, 2018 In lieu of the filing fee, this petition must be filed in the County Clerk's Office with the Declaration of Candidacy by candidates for all countywide offices during the above filing period. The statutorily required number of signatures must be verified by the County Clerk prior to filing. Office Information Filing for the Office of: Candidate Information Candidate Name As it will a ear on the ballot Signers Statement I, the undersigned, being a qualified elector of 10. County in the State ofldaho, do hereby certify and declare that I reside at the place set opposite my name, and that I join in the petition of the candidate for the party and office listed above to appear on the Primary Election ballot on May 15th, 2018, and that each for himself says: I have personally signed this petition; I am a qualified elector of the County listed above and the State of Idaho and my residence address is correctly written after my name. 9,IL ' I Certification STATE OF IDAHO ss. /l County of L-4 5 S I C<., I, ls {2/J/# K.b. /7) - &-----cj:.., being first duly sworn say: That I am a resident of the State of Idaho and at least eighteen (18) years of age: that eveiy person who signed this sheet of the foregoing petition signed his or her name thereto in my presence: I believe that each has stated his or her name, address and re dence correctly, that each signer is a qualified elector of the State of Idaho, and a resident of the county of ::5 J fa. '.v cfrculatorsignature: ~ Address: ;}.?;? Jri}. ;;lcjcj So".,,~ it'i/, ;-:7 Subscribed and sworn to before me this \ day of {Y}C\(G~, lo\ x'..,,,,~~~.. ~~N~~,.,,,.# _,,.--/..,/... ""......,... Notary Signature: ~-~ ~,..,,.---~~ ::: ~....,:. =.: o"tary \ ~ Notaiy Public in and for the State ofldaho, residing at (Notary Seal) = : ~ - - : =?,-1<..t0 :: : c,. - ~ '-i -:. \' UB'--' /oe My Commission Expires: ( / l'z (lo-z ~ "=-,,, \J';...../ ~,2 EC-10A - Petition for Candidacy fo/ Coun~ Offices - Approved by the Secreta1y of State, December 2017 v.,,, ;".,.'fi Of\'O ~,,',,,,,,1111\''

3 Susan Keck Elections/Social Services Director Janel Bench Elections/Social Services Assistant Director Elections and Social Services Office Joseph W. Larsen, Clerk of the District Court Cassia County Courthouse 1459 Overland Ave. Room 105 Burley ID Phone:(208) Fax: (208) STATE OF IDAHO COUNTY OF CASSIA To Whom It May Concern: The Elections Office of Cassia County, Idaho, does hereby certify that _ (six) signatures on this petition for Leonard Beck, for the position of County Commissioner, District# 1, are those of qualified electors. Dated this 06 day of March, 2018 Joseph W. Larsen Cassia County Chief Elections Officer,,\\\\\\\\111111///fltt...,,{~:,,:: rn~m~''''i';,. ~'',<, n'-;..,... 'C;t- '1-, ~ (f.. ~ :-..:, Q", 1...,.".~;.. 4' -,.., ,, r I. ff~ (~~al of Offi~6)~ u:-: C.: \~ \~~ - -,.... JJ - ~0\,, :o~ :.;:~ (.,\. - ~,,. -~.. J.. ~ '*,,,, 1 :\..- \, I, ', ~) ~- ~ Iii'.:, ~.. L,. t, :,,...,~",;,,,, )~ ~ l --~ %~1- " CO\.)\'\ ~,,,, ~ ,\'~ by:~~ Susan M. Keck, Deputy Clerk llp a ge

4 Cassia County Petition Signature Verification Codes The following letters will be used by the Cassia County Elections Office to indicate why a petition signature was declared invalid. All notations will be made in RED INK. If there is no notation, the signature is valid. N - Not Registered-The signer is not registered to vote in Cassia County. D - Duplicate Signature - The signer has already signed this petition. A - Address is Incorrect - Signer's address on petition does not match their address in the voter registration system, signer used a P.O. Box, or signer provided multiple addresses. I - Name and/or Address are Illegible. S - Signature does not reasonably match the signature on the signer's Voter Registration Card. 0 - Out of Cassia County. Signer does not live within Cassia County. This signature may be taken to the proper county for validation. R - Registered to vote within Cassia County, but NOT within the specific Taxing District, Sub-District or Municipality for which they signed. NI- Notary section is incomplete.

5 C-1 Rev. 1/18 APPOINTMENT AND CERTIFICATION OF POLITICAL TREASURER FOR CANDIDA TE (Please Print or Type) Pursuant to Section (c \ ), Idaho Code. No contribution shall be received or expenditure made by or on behalf of a candidate or political committee until the he or she appoints a political treasurer and certifies the name and address of the treasurer to the County Clerk. Name of Candidate: Home Phone: Office_// SouglnLOU/.1 Candidate Mailing Address: Candidate Address: / ;}._, hj I Work Phone: c5< tj District } Number: 0ihou. cdi?") Cell Phone: 2lJ, --3 /2 -, ~ j -.5~ - Party: Re (It b( ~ ~tetlll21 -&d, hereby certify and appoint the following individual who is a registered elector of the state of Name 0JC011didate Idaho as the political treasurer for the above named candidate or co1timittee: Name of Political : f/eµ R.t{ CERTIFICATION AND APPOINTMENT V :\/o,j Kuc/<fi I Home Work Cell Phone: :2o'8 &1q 'i7b9 Phone: 1o'ii t1j <-(If Zo Phone: ;lo ;f t 7tl ;21$6 Mailing Address: 5/8 l1i./esr ;;z,7-il 5r err 8uJ?t..a1 :rb. R33)J? Residence Address: Si 8 /1\f E~-r' J..71 S-rA.a r 8uie.Le71 :Z: Address: 8 9 u t3oc.ulef(<._@, I). C O ti\ I c tt_ : Signature of Candidate RETURN THIS FORM TO: Joseph W. Larsen, Cassia County 1459 Overland Ave., Burley