Independent School District 833

Independent School District 833 School Board Candidate Filing Information 2015 INDEPENDENT SCHOOL DISTRICT 833 South Washington County Schools 7362 East Point Douglas Road South Cottage Grove, MN 55016 651-425-6300

INDEPENDENT SCHOOL DISTRICT 833 2015 CANDIDATE INFORMATION This packet contains selected general information regarding the candidate filing and election process for school district offices. The process is principally governed by Minnesota Statutes, Chapter 200 through 211B. Please refer to these sources for more complete information. If you have any questions pertaining to the election, feel free to call the district office at 651-425- 6300 or the Secretary of State s Office at 651-215-1440. TABLE OF CONTENTS Letter from the Superintendent 3 District Profile 4-7 School Board Member Duties 8-9 Filing for Office 10 Candidate Qualifications 10 Affidavit of Candidacy 11 Filing Fees or Petitions 11 Election Dates 11 Campaign Financial Reporting 12-13 Fair Campaign Practices 14 Campaign Signs 14 Important Dates 15 ATTACHMENTS ENCLOSED: Minnesota Affidavit of Candidacy Campaign Financial Report Affidavit of Withdrawal Minnesota Campaign Manual Minnesota Department of Transportation letter Washington County Department of Transportation letter Secretary of State Map Order Form Secretary of State Voter Registration List Request Secretary of State Precinct Finder, Table, & Polling Place Request 2

South Washington County Schools Keith Jacobus, Ph.D., Superintendent District Service Center 7362 E. Point Douglas Rd. S. Cottage Grove, MN 55016 Phone: 651-425-6300 Fax: 651-425-6318 Dear Prospective School Board Candidate: Thank you for your interest in the South Washington County School Board. Serving as a School Board member is one of the most important responsibilities that a citizen can undertake. If elected, the educational standards that you establish, with your fellow Board members, will affect the future of the students and the community. Being a board member is a complex and varied position, and often is frustrating as you struggle long hours with difficult choices. However, it is also rewarding as you watch students succeed and go on to lead productive lives as the result of educational opportunities you helped to create. There are certain implications in being responsible for the entire district that you may want to consider. Decisions need to reflect what is in the best interest of all students and all citizens. This demands a constant effort and strong commitment to serving other people. Effective school board members share a number of common characteristics, but it's important to realize they did not become effective the instant they were elected. Many qualities are acquired through experience and are important to consider: a conviction that public education is important; the ability to make decisions; loyalty to the democratic process; time and energy to devote to board business; the ability to accept the will of the majority; respect for district staff and; the ability to communicate well with others. A typical month in the life of a School Board member will involve many hours. There is a minimum of two School Board meetings per month. In addition to those meetings, there are special meetings, committee meetings, buildings visits, event appearances - and the list goes on. We applaud your interest in the School Board and thank you for your willingness to devote your talents and time to meeting these challenges. The materials enclosed have been prepared for your benefit. Please read through the information. If you are interested in filing for the School Board, please complete the Affidavit of Candidacy form. Bring the completed form to the District Service Center, located at 7362 E. Point Douglas Rd. S., Cottage Grove, MN 55016, to have it notarized (bring a picture ID). There is a $2 filing fee that will be due at the time of submission. If you have any questions about the School Board, please don t hesitate to call me or my assistant, Dayna Bentdahl, at 651-425-6201 for a phone conversation or to schedule an appointment. I wish you good fortune in your campaign. Sincerely, Keith Jacobus Superintendent of Schools We are committed to igniting a passion for lifelong learning. www.sowashco.org 3

Our Mission Statement South Washington County Schools is committed to igniting a passion for lifelong learning. District Profile 4

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School Board Duties 1. A seven-member School Board governs the district. Board members are elected at-large on Election Day in November of odd numbered years and begin service in January after they are elected. The Superintendent of Schools is an ex-officio, non-voting, member of the Board. 2. School Board meetings are held twice a month at the District Service Center, 7362 East Point Douglas Road South in Cottage Grove. The public is welcome to attend these meetings. Board meetings are cablecast live on local Channel 15 and repeated several times between meetings. Meetings are also webstreamed on the district website via a program called Granicus. 3. Several other events occur throughout the year for School Board members. They include, but are not limited to, training sessions, special meetings, committee meetings, buildings visits, event appearances, and negotiation sessions. This does not take into account the phone calls and emails you will receive as well. 4. School Board members are compensated at $400 per month, plus $50 per month for expenses they incur (i.e.: mileage, supplies, etc.). 5. The South Washington County School District is a member of the Minnesota School Boards Association (MSBA). MSBA supports, promotes and enhances the work of public school boards (www.mnmsba.org). The work of the MSBA is divided into six major divisions - Administration/Governance, Board Development/Training, Public Relations/Communications, Governmental Relations, Management Services, and Policy Services. 6. Roles and Responsibilities of the School Board as outlined by MSBA: The major function of the School Board is to provide leadership, policy development, policy oversight and communication. This is usually accomplished by adopting policies which the administrators and staff carry out. A. Areas for which the board is responsible for policy include but are not limited to: Educational program development and monitoring Student assessment Student support services Employee relations including hiring, in-service and evaluation Instructional materials Facility use Extracurricular activities Board operations 8

B. Other board roles include: Budget adoption, revenue management and expenditure authorization Superintendent selections, contract and evaluation Long range planning Ratifying collective bargaining agreements Legislative involvement C. The qualities of leadership that have been identified are: integrity, perseverance, commitment, ability to plan, vision, initiative and courage. Effective board members share a number of these characteristics and are also able to work as a team member. 7. 10 Guidelines for School Board Meetings: Attend all regularly scheduled meetings; Recognize decisions are made by the Board as a whole; Delegate authority for administration to the Superintendent; Focus on policy making, goal setting, planning and evaluation; Become informed and base all decision on available facts; communicate at appropriate times; Encourage free expression of opinions; Refuse to surrender judgment to individuals or special groups; Respect confidentiality of information; Make decisions on the educational welfare of all students. 8. If you would like more information or have questions: Check out our website at www.sowashco.org Watch local Cable Channel 15 Call the Superintendent s Office at 651-425-6201 for a phone conversation or to schedule an appointment 2015 Open Seats For the 2015 Election, South Washington County Schools has the following open seats: 3 School Board Member Positions for 4 Years 9

Filing for Office When to File: Filing for Independent School District 833 Board Members opens Tuesday, July 28, 2015 and ends at 5:00 p.m. on Tuesday, August 11, 2015. The filing fee for office is $2. A candidate who provides the filing fee by a check or other instrument for which sufficient funds are not available will have his or her name removed from the ballot and is liable for all costs incurred by election officials in removing the name from the ballot (MS 204B.11). A candidate for a school district elective office may withdraw from the election by filing an affidavit of withdrawal with the school district clerk no later than 5:00 p.m. on August 13, 2015. After that date, no candidate may file an affidavit of withdrawal. Filing fees are not refundable. July/August 2015 Sun Mon Tue Wed Thu Fri Sat 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Where to File: File at the Independent School District 833 Office: 7362 E. Point Douglas Rd. S., Cottage Grove, MN 55016. The telephone number is 651-425- 6300 for these offices. Qualifications for candidates filing for Independent School District 833 Board Member: Eligible voter At least 21 years of age when assuming office Resident of district for 30 days preceding the General Election Has not filed for another office in the same Election Is not a registered sex offender (M.S. 204B.06 subd1: M.S. 205A.06, subd1b.). 10

Affidavit of Candidacy An individual who is eligible and desires to become a candidate for an office to be voted on at the election must file an affidavit of candidacy with the school district clerk. The affidavit must be in substantially the same form as that in section 204B.06 subdivision 1. The school district clerk shall also accept an application signed by at least five voters and filed on behalf of an eligible voter in the school district whom they desire to be a candidate, if service of a copy of the application has been made on the candidate and proof of service is endorsed on the application being filed. No individual shall be nominated by nominating petition for a school district elective office. Upon receipt of the proper filing fee, the clerk shall place the name of the candidate on the official ballot without partisan designation. Affidavits of candidacy for municipal and school district candidates must be filed during the applicable filing period. The affidavit must be signed in the presence of a notarial officer. Filings are not complete without the filing fee or petition filed in lieu of the fee. The candidate should be prepared to supply satisfactory evidence of identification. All candidates, including those filing by petition, must file affidavits stating, in part: The name of the office sought; That the candidate is an eligible voter; That he/she has no other affidavit on file for any other office for the election; That the candidate meets the qualifications for the office; and That the name listed on the affidavit is the candidate s true name or name by which the candidate is commonly known in the community. Filing Fee (or Petition in Lieu of Filing Fee) To petition in lieu of a filing fee, five or more voters may draft a candidate by filling an application on behalf of a candidate with the clerk. The candidate must indicate his or her willingness to run by signing the application. The petition in lieu of a filing fee must have signatures of people who are eligible to vote in the election, either 500 signatures or a number equal to 5% of the total number of persons who voted in the last general election when the office was on the ballot (whichever is less) (M.S. 204B.11, subd 2; M.S. 205A.06, subd. 3 and 4). 2015 Election General Election: Tuesday, November 3, 2015 11

Campaign Financial Reporting Campaign Finance Reports: Minnesota Statute 211A generally regulates campaign reporting requirements of candidates and committees supporting school districts or other political subdivisions candidates for office and questions Candidates and committees supporting candidates for judicial office are not regulated by Chapter 211A. Minnesota Statute 211B regulates a variety of campaign practices and applies to all federal, state, and local candidates. It also regulates the activities of committees formed to promote or oppose ballot questions and proposed constitutional amendments. Candidates and their committees for elective office are responsible for adherence to the provisions of Minnesota Statutes 211A and 211B regarding Campaign Financial Reporting and Fair Campaign Practices. Enclosed for your use are the following: Minnesota Campaign Manual This contains a digest and the text of Chapters 211A and 211B. Campaign Financial Report Forms These are to be filed as indicated by the provisions of M.S. 211A.02 As a candidate for school district elective offices, you are responsible for fulfilling the requirements of Minnesota Statutes Chapter 211A Campaign Financial Reporting. A summary of several important dates regarding Campaign Financial Reporting related to the General Election is as follows. Initial Report A committee or a candidate who receives contributions or makes disbursements of more than $750 in a calendar year shall submit an initial report to the filing officer within 14 days after the candidate or committee receives or makes disbursements of more than $750. Reporting dates for candidates and committees required after the initial report are as follows: 10 days before the General Election October 23, 2015 Campaign Financial Report Certification of Filing November 10, 2015 12

Each school district level candidate shall certify to the filing officer that all reports required by Minnesota Statutes 211A.02 have been submitted to the filing officer or that the candidate or committee has not received contributions or made disbursements exceeding $750 in the calendar year. The certification shall be submitted to the filing officer no later than seven days after the general election. A certification of election will not be issued to a candidate who has not certified that all reports required by Section 211A.02 have been filed. 30 days after the General Election December 3, 2015 January 31, 2016 The committee or candidate must file a report by January 31 of each year following the year when the initial report was filed. Final Report A candidate or committee may file a final report when all debts have been settled and all assets in excess of $100 in the aggregate are disposed of. The final report may be filed at any time and must include the kinds of information contained in the financial statements required by Section 211A.02 for the period from the previously submitted report to the date of the final report. Notice of Failure to File If a candidate or committee fails to file a report on the date it is due, the filing officer shall immediately notify the candidate or committee of the failure to file. If a report is not filed within ten days after the notification is mailed, the filing officer shall file a complaint under section 211B.32 THIS IS ONLY A SUMMARY TO HELP INFORM YOU REGARDING REPORTING DATES AND REQUIRMENTS. PLEASE REFER TO THE FULL TEXT OF MINNESOTA STATUTES CHAPTER 211A FOR THE COMPLETE INFORMATION. Electronic Filing of Financial Reports Financial reports requires under Minnesota Statutes 211A.02 may be filed electronically, subject to the approval of the filing officer (MS 211A.02,Subd. 5). 13

Fair Campaign Practices Minnesota Statute 211B governs fair campaign practices. Candidates must comply with regulations concerning campaign contributions and spending, Election Day campaigning, advertising, influencing voters, and other campaign activities. Questions? Call the Washington County Elections Division at 651-430-6790 Campaign Signs Contact the clerk in any community where you will campaign if you plan to post political signs and have any questions as to any local sign regulations. Placing signs on State or County rightof-way is prohibited. Minnesota Statute 160.27 prohibits advertisements on highway right-ofways. See attached letters from Minnesota Department of Transportation and County Transportation Department. If signs are to be placed on private property, permission must be obtained from the landowner. Any signs that are in the highway right-of-way will be removed. The telephone numbers for the cities and townships in Washington County are as follows: CITIES/TOWNSHIPS PHONE AFTON 651-436-5090 COTTAGE GROVE 651-458-2814 DENMARK 651-436-1704 GREY CLOUD ISLAND 651-459-6236 NEWPORT 651-459-5677 ST. PAUL PARK 651-459-9785 WOODBURY 651-714-3522 14

2015 Important Election Dates Filing for Office: July 28 August 11 August 13 First day to file affidavits of candidacy for city offices Last day to file affidavits of candidacy for city offices Last day to file affidavits of withdrawal for city offices Election Dates: Sept. 18-Nov. 2 October 13 October 31 November 3 January 5, 2016 Absentee voting End of pre-registration of voters for general election Saturday hours of 10am 3pm for absentee voting General Election Day School Board Term begins Important Financial Reporting Dates More than $750 (contribution/disbursements) Within 14 days: Of receiving or disbursing more than $750 in a calendar year October 23: Pre-general election campaign financial reports due December 3: Post-general election campaign financial reports due January 31: Annually until all debts have been settled and all assets in excess of $100 in the aggregate are disposed of, at which a final report is filed $750 or less (contribution/disbursements) November 12: Certificate of filing due 15

Office of the Minnesota Secretary of State AFFIDAVIT OF CANDIDACY Filing # Cash/Check # Amount Instructions All information on this form is available to the public. Information provided will be published on the Secretary of State s website. If filing for partisan office and not a major party candidate, you must file both an affidavit of candidacy and a nominating petition. (Minn. Stat. 204B.03) Candidate Information Name and Office Candidate Name (as it will appear on the ballot) Office Sought District # For Partisan Office, Provide Political Party or Principle For Judicial Office, Provide Name of Incumbent Residence Address Do not complete if residence address is to be private and checkbox below is marked. All address and contact information is optional for federal, judicial, county attorney, and county sheriff office candidates. Street Address City State Zip Code My residence address is to be classified as private data. I certify a police report has been submitted or I have an order for protection for my (or my family s) safety, or my address is otherwise private by Minnesota law. I have attached a separate form with my residence address. Campaign Address and Contact Candidate Phone Number (Required) Campaign Contact Address (Required for those who have checked the box above): Street Address City State Zip Code Website Email Affirmation For all offices, I swear (or affirm) that this is my true name or the name by which I am generally known in the community. If filing for a state or local office, I also swear (or affirm) that: I am eligible to vote in Minnesota; I have not filed for the same or any other office at the upcoming primary or general election (except as provided in M.S. 204B.06, subd. 1 (2) ); I am, or will be on assuming office, 21 years of age or more; I will have maintained residence in this district for at least 30 days before the general election; and If a major political party candidate, I either participated in the party s most recent precinct caucuses or intend to vote for a majority of that party s candidates at the next general election. If filing for one of the following offices, I also swear (or affirm) that I meet the requirements listed below: United States Senator I will be an inhabitant of this state when elected and I will be at least 30 years old and a citizen of the United States for not less than nine years on the next January 3rd, or if filled at special election, within 21 days after the election. United States Representative I will be an inhabitant of this state when elected and I will be at least 25 years old and a citizen of the United States for not less than seven years on the next January 3rd, or if filled at special election, within 21 days after the election. Governor or Lieutenant Governor I will be at least 25 years old on the first Monday of the next January and a resident of Minnesota for not less than one year on election day. I am filing jointly with Supreme Court Justice, Court of Appeals Judge, District Court Judge, or County Attorney I am learned in the law and licensed to practice law in Minnesota. My Minnesota attorney license number is and a copy of my license is attached. State Senator or State Representative I will be a resident of Minnesota not less than one year and of this district for six months on the day of the general or special election. County Sheriff I am a licensed peace officer in Minnesota. My Board of Peace Officer Standards and Training license number is and a copy of my license is attached. School Board Member I have not been convicted of an offense for which registration is required under Minn. Stat. 243.166. County, Municipal, School District, or Special District Office I meet any other qualifications for that office prescribed by law. Candidate Signature Date Subscribed and sworn to before me this day of, 20. Notary public or other officer empowered to take and certify acknowledgement (Notary stamp) White Copy Filing Officer Yellow Copy CFPD Board Pink Copy Public Information Goldenrod Copy Candidate Rev. 5/2015

For Office Use Only: Name Office Report CAMPAIGN FINANCIAL REPORT (All of the information in this report is public information) Name of candidate, committee or corporation Office sought or ballot question District Type of report Candidate report Campaign committee report Association or corporation report Final report Period of time covered by report: from to CONTRIBUTIONS RECEIVED Give the total for all contributions received during the period of time covered by this report. Contributions should be listed by type (money or in-kind) rather than contributor. See note on contribution limits on the back of this form. Use a separate sheet to itemize all contributions from a single source that exceeded $100 during the calendar year. This itemization must include name, address, employer or occupation if self-employed, amount and date for these contributions. CASH IN-KIND TOTAL AMOUNT RECEIVED $ + $ = $ TOTAL CASH-ON-HAND $ EXPENDITURES Include the amount, date and purpose for all expenditures made during the period of time covered by report. Attach additional sheets if necessary. Date Purpose Amount TOTAL CORPORATE PROJECT EXPENDITURES Corporations must list any media project or corporate message project for which contribution(s) or expenditure(s) total more than $200. Submit a separate report for each project. Attach additional sheets if necessary. Project title or description Date Purpose Name and Address of Recipient Expenditure or Contribution Amount TOTAL I certify that this is a full and true statement. Signature Date Printed Name Telephone Email (if available) Address

INSTRUCTIONS (Reference: Minnesota Statutes, Chapters 211A and 211B) This CAMPAIGN FINANCIAL REPORT is for use by candidates and committees for county, municipal, school district and special district office who receive contributions or make disbursements of more than $750 in a calendar year; committees or corporations spending more than $750 for or against a ballot question in a calendar year; and corporations spending more than $200 on activities to encourage participation in precinct caucuses, voter registration or voting. Where to file this report: Hospital Districts Park Districts School Districts Townships Cities Soil & Water Conservation Districts Counties The municipal (city or town) clerk same place where filed affidavit of candidacy The county auditor or municipal clerk same place where filed affidavit of candidacy School district clerk Town clerk City clerk County auditor County auditor Candidate or committee report: The initial report must be filed within 14 days after the candidate or committee receives contributions or makes disbursements of more than $750 in a calendar year. Subsequent reports must be filed. During an Election Year - An election year is any year in which the candidate s name or a question appears on the ballot. In such a year (if an initial report has been filed) reports are required to be filed: 10 days before the primary or special primary 10 days before the general election or special election 30 days after a general election or special election By January 31 of each year following the year when the initial report was filed. During a non-election year - By January 31 of each year following the year when the initial report was filed. Once a final report* is filed, no further subsequent reports are required to be filed. CONTRIBUTIONS: Means anything of monetary value that is given or loaned to a candidate or committee for a political purpose. Contribution does not include a service provided without compensation by an individual. Each candidate or committee must list the total amount of cash-on-hand as of the close of the reporting period. CONTRIBUTION LIMITS: Candidates or candidate s committees for county, municipal, school district offices may not accept aggregate contributions in excess of $600 in an election year or in excess of $250 in a non-election year made or delivered by an individual or committee. However, candidates seeking election from districts with a population in excess of 100,000 may not accept aggregate contributions in excess of $1,000 in an election year and $250 in a non-election year. BALLOT QUESTIONS: Any political committee, association or corporation that makes a contribution or expenditure to promote or defeat a ballot question as defined in Minnesota Statutes, section 211A.01 shall file reports with the filing officer responsible for placing the question on the ballot. Reports must be filed within 14 days of receiving contributions or making disbursements of more than $750 in one calendar year, using the same schedule as above. CONGRESSIONAL CANDIDATES: Candidates for election to the United States House of Representatives and Senate and any committee raising funds exclusively on behalf of any one of those candidates may file copies of the reports required by federal law in lieu of those required by Minnesota Statutes Chapter 211A. CORPORATE ACTIVITIES TO ENCOURAGE PARTICIPATION: Corporations may contribute to or conduct public media projects to encourage individuals to attend precinct caucuses, register or vote if the projects are not controlled by or operated for the advantage of a candidate, political party or committee. The total amount of expenditures or contributions for any one project greater than $200, together with the date, purpose and the names and addresses of the persons receiving the contribution or expenditures must be reported. Reports must be filed with the Secretary of State, 180 State Office Building, St. Paul, MN 55155-1299, using the same schedule as above. *FINAL REPORT: A final report may be filed any time after the candidate, committee or corporation has settled all debts and disposed of all assets in excess of $100 in the aggregate. Check final report under type of report. PROHIBITED TRANSFERS: Candidates for county, municipal, school district or special district offices may not accept contributions from the principal campaign committees of any candidate for legislative, judicial or state constitutional office. In addition, a candidate may not make contributions to the principal campaign committee of any candidate for legislative, judicial or state constitutional office unless the contributions are made from the candidate s personal funds. STATE CANDIDATES: Candidates and committees for state constitutional offices, the state legislature, supreme court, court of appeals, district court and committees for state constitutional amendments are governed by Minnesota Statutes Chapter 10A. Contact the State Campaign Finance and Public Disclosure Board for further information at (651) 539-1180. Note: The filing officer must restrict public access to the address of any individual who has made a contribution that exceeds $100 and who has filed with the filing officer a written statement signed by the individual that withholding the individual s address from the financial report is required for the safety of the individual or the individual s family. Updated 5/20/2014

AFFIDAVIT OF WITHDRAWAL STATE OF MINNESOTA ) ) SS. ) COUNTY OF WASHINGTON, being first duly sworn on oath, says that on the day of,, he/she filed as a candidate for the office of Washington County, Minnesota, to be voted upon at the Election to be held November 3, 2015; that he/she no longer desires to be a candidate for said office, and he/she hereby withdraws as a candidate for said office, and he/she hereby requests the of to cancel said filing and to keep his/her name off of the ballot as a candidate for said office. He/she further acknowledges that this instrument is executed by him/her as his/her free act and will. Signature of Affiant Subscribed and sworn to before me this day of,. Notary This form must be filed "no later than two days after the last day for filing for the office." (MS 204B.12, Subd. 1)

Office of the Minnesota Secretary of State Map Order Form Contact Information Name Address City, State and Zip Code Phone or email Order will be picked up from State Office Building Ship to address above via UPS Ground ($3.50) Available Maps Maps usually include congressional district, legislative district, county, city, township, and precinct boundaries, and physical features such as roads, railroads, rivers and lakes, depending on scale. Please select from the following available maps and indicate quantity, size and desired jurisdiction, as applicable. Available sizes are large (36 by 48 ), medium (17 by 22 ) and small (8.5 by 11 ), unless otherwise indicated. Statewide legislative and congressional districts. Quantity and size Metropolitan area legislative and congressional districts (large size only). Quantity Individual congressional districts (large size only). Quantity and district(s) Individual state house or senate districts. Quantity, size and district(s) County, showing legislative districts (large size only). Quantity and county County, showing commissioner districts (large size only). Quantity and county Individual school district (large size only). Quantity and school district Individual city or town (large size only). Quantity and municipality Additional information Cost, delivery and payment Map prices are $11 per large map, $9 per medium map, and $7 per small map. Maps may be shipped via UPS for $3.50 per order, or picked up from the State Office Building (address below). Full payment must be submitted with this request. Checks or money order are accepted via mail. Cash is also accepted when ordering in person. Allow five to ten days for processing. Return completed form and payment to: Minnesota Secretary of State Elections Division 180 State Office Building 100 Dr. Rev. Martin Luther King, Jr. Blvd. Saint Paul MN 55155 For questions, call 651-215-1440 or email elections.dept@state.mn.us Disclaimer This document can be made available in large print by calling (651) 296-2803/Voice, or on our Web site at www.sos.state.mn.us. For TTY communication, contact the Minnesota Relay Service at 1-800-627-3529 and ask them to place a call to (651) 215-1440. The Secretary of State s Office does not discriminate on the basis of race, creed, color, sex, sexual orientation, national origin, age, marital status, disability, religion, reliance on public assistance or political opinions or affiliations in employment or the provision of services.

Rev. 4/24/2013 MINNESOTA SECRETARY OF STATE VOTER INFORMATION REQUEST FORM Page 1 of 2 The use of voter registration information for purposes unrelated to elections, political activities or law enforcement is a violation of Minnesota law (M.S. 201.091). Voter Information Enter your name as it would appear on your voter record. Name Address City State Zip Code email Phone Order(s) Order #1 (Make selections below) Jurisdiction Type: Jurisdiction Name: (if not statewide) *Text files require specific software to use. See page #2 for more information. Report Type: (Statewide reports are available in text format only) If requesting information for a Specific Election, enter election date and type of election below Order #2 - Optional (Make selections below) Jurisdiction Type: Jurisdiction Name: (if not statewide) Report Type: (Statewide reports are available in text format only) If requesting information for a Specific Election, enter election date and type of election below Delivery Enter delivery information below. (Shipped orders will be sent via UPS Ground Service) I will pick my order up at the: *Ship my order to: (*include $5 shipping cost) Retirement Systems of Minnesota Building 60 Empire Drive, Suite #100 Saint Paul, MN 55103 Name Address City State Same as Residential Address Zip Code Payment Enter payment information below. Payment Type: Order Total: ($) + Shipping: = Amount Included: Mail order and payment to: (Do not mail cash) Office of the Secretary of State Voter Registration Lists 60 Empire Dr Suite 100 Saint Paul, MN 55103 Certification Certify your request. Type your initials in the box below to the left, enter date, print and sign. I CERTIFY THAT I AM A REGISTERED VOTER IN THE STATE OF MINNESOTA AND THAT THE INFORMATION IN THIS LIST OF REGISTERED VOTERS WILL BE USED ONLY FOR PURPOSES RELATED TO ELECTIONS, POLITICAL ACTIVITIES, OR LAW ENFORCEMENT (M.S. 201.091). SIGNATURE: Date: Offcial Use Only Date Rec'd by Fiscal Date Rec'd by Med Prod Client Act # Amount Paid Work Order #

Revised 10/08/2012 MINNESOTA SECRETARY OF STATE PRECINCT FINDER & POLLING PLACE LIST REQUEST NAME DAY PHONE ( ) EMAIL RESIDENTIAL ADDRESS: (No P.O. Boxes) CITY STATE/ZIP MAIL ADDRESS (if different then residential address- (No P.O. Boxes) MAIL CITY, STATE & ZIP WILL PICK UP (60 Empire Drive, St Paul MN 55103) PLEASE MAIL (Include an additional $5.00 for mailing fees) PRECINCT FINDER Please check only one of the following options and provide one jurisdiction name (excluding Statewide): Additional jurisdictions may be purchased by completing additional order forms. Statewide (CD-ROM DATA FILE ONLY) County City or Township School District Other Please check one of the formatting options listed below: CD-ROM PDF PRECINCT FINDER REPORT FOR PRINTING The report is generated in PDF format and ready for printing. An example of this PDF file is available at www.sos.state.mn.us. CD-ROM DATA FILE PRECINCT FINDER IN COMMA DELIMITED TEXT FORMAT Files are parsed and in comma delimited format with field headings in the first line. Users will need application software (e.g. Microsoft Excel or Microsoft Access), not supplied by the Secretary of State, to access this data. An example of this data file is available at www.sos.state.mn.us. The precinct finder contains voting districts by street name and house number ranges within a city/township of a county. Voting districts include precinct, ward, MCD code, county number, congressional, legislative, state senate, judicial, county commissioner, city/township, school district and county determined special districts. POLLING PLACE LIST FOR ELECTION Please check one of the following options and provide the jurisdiction name (excluding Statewide): Specify Election Name & Date Statewide (CD-ROM DATA FILE ONLY) Countywide for County Please check one of the formatting options listed below: CD-ROM PDF POLLING PLACE LIST FOR ELECTION The report is generated in PDF format and ready for printing. An example of this PDF file is available at www.sos.state.mn.us. CD-ROM DATA FILE POLLING PLACE LIST FOR ELECTION IN COMMA DELIMITED TEXT FORMAT Files are parsed and in comma delimited format with field headings in the first line. Users will need application software (e.g. Microsoft Excel or Microsoft Access), not supplied by the Secretary of State, to access this data. An example of this data file is available at www.sos.state.mn.us. The polling place list contains a record for each precinct in the state. The record has the county name (CD ROM contains County number only), the state-assigned precinct number, precinct name, polling place status and type, polling place address, MCD code, ward #, commissioner district, legislative district, congressional district, polling place description and number. Date Rec d by Fiscal Date Rec d by Med Prod Client Act # Amount Paid Work Order #

Revised 2/14/2008 MINNESOTA SECRETARY OF STATE PRECINCT FINDER & POLLING PLACE LIST PRICES The following prices are for the purchase of CD-ROM Precinct Finder Data File/Polling Place List for Election from the Office of the Secretary of State. Full payment is due at the time of request. If you have questions please contact the Office of the Secretary of State at (651) 201-1378.. CD-ROM PDF PRECINCT FINDER REPORT FOR PRINTING All other jurisdictions $30.00 CD ROM PRECINCT FINDER DATA FILE IN COMMA DELIMITED TEXT FORMAT Statewide List $46.00 All other jurisdictions $30.00 Files are parsed and comma delimited, with field headings in the first line. User will need application software (e.g. Microsoft Excel or Microsoft Access), not supplied by the Secretary of State, to access this data. CD ROM PDF POLLING PLACE LIST FOR ELECTION REPORT FOR PRINTING All other jurisdictions $30.00 Precinct Finder a list of house and unit ranges within a street address which contains precinct code name, city, zip, county, voting district information and range ID. Polling place list by Election - contains a record for each precinct in the state which includes precinct code name, polling place status, polling place name and address, type, county code and polling place district information. CD ROM POLLING PLACE LIST FOR ELECTION DATA FILE IN COMMA DELIMITED TEXT FORMAT Statewide $46.00 All other jurisdictions $30.00 Files are parsed and in comma delimited format with field headings in the first line. User will need application software (e.g. Microsoft Excel, Microsoft Access), not supplied by the Secretary of State, to access this data. Mailing Costs All orders will be sent UPS at a cost of $5.00. Please mail your request and fee (make checks payable to Secretary of State ) to: Office of the Secretary of State Voter Registration Lists 60 Empire Dr Suite 100 Saint Paul, MN 55103 This document can be made available in alternative formats, such as large print, Braille or audio tape, by calling (651) 201-1378/Voice, or on our Web site at www.sos.state.mn.us. For TTY communication, contact the Minnesota Relay Service at 1-800-627-3529 and ask them to place a call to (651) 201-1378. The Secretary of State s Office does not discriminate on the basis of race, creed, color, sex, sexual orientation, national origin, age, marital status, disability, and religion, reliance on public assistance or political opinions or affiliations in employment or the provision of services.

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