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JUDGE OF ELECTION & INSPECTOR OF ELECTION The offices of Judge of Election and Inspector of Election will appear on this year’s ballot for a four year term beginning in 2022. If you are interested in running for either of these positions, it will be necessary for you to complete and file the enclosed petition to have your name placed on the 2021 Primary ballot. This year’s Primary Election will be held on Tuesday, May 18, 2021.

This petition requires the signatures of registered voters enrolled in the party of which you are running and living within your voting precinct. To confirm which precinct you are registered in, please visit www.montcopa.org/voteinperson. You may collect signatures between the dates of FEBRUARY 16, 2021 and MARCH 9, 2021. ANY SIGNATURES COLLECTED OUTSIDE OF THESE DATES WILL BE INVALID. Petitions must be filed in the Election Board office by 4:30pm on Tuesday, March 9, 2021. Please note that post marks do not apply.

The following information is a guide to assist you in properly completing your petition. If you have any additional questions, please feel free to contact the Election Board office at 610-278-3275.

INSTRUCTIONS FOR PETITIONS

1. ALL blank spaces which appear at the top of each petition must be completed BEFORE

signatures are obtained. Be sure to include your zip code.

2. Type or print the name of the candidate on the face of the petition EXACTLY as the candidate would like it to appear on the ballot.

3. DO NOT begin collecting signatures prior to FEBRUARY 16, 2021.

SIGNATURE REQUIREMENTS AND FILING FEES

OFFICES NUMBER OF FILING FEE SIGNATURES JUDGE OF ELECTION MINIMUM 10 NONE INSPECTOR OF ELECTION** MINIMUM 5 NONE

** Please note that the office is “Inspector of Election”. The title of Majority Inspector will be awarded to the candidate who receives the highest number of votes in November; Minority Inspector will be awarded to the candidate receiving the second highest number of votes in November.

SIGNERS

1. Each signer of a petition must be a registered and enrolled elector of the Party referred to in the petition. Republican electors can only sign Republican petitions and Democratic electors can only sign Democratic petitions. 2. Each signer must reside in the voting precinct in which you are seeking office. 3. The signer’s address should be as it appears on their registration affidavit. The municipality must be listed. The date of signing may be expressed in words or numbers (February 16, 2021 or 2-16-21).

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4. The use of ditto (“) marks is grounds for rejecting the petition.

5. You may sign your own petition.

STATEMENT OF CIRCULATOR AND CANDIDATE’S AFFIDAVIT

1. THE STATEMENT OF CIRCULATOR ON EACH PETITION MUST BE FILLED OUT ANDSIGNED AFTER EACH PETITION IS CIRCULATED.

The candidate must complete the Candidate’s Affidavit. In the case of multiple petitions, only ONE

Candidate’s Affidavit need be completed and notarized. For 2021, if you are unable to get your

affidavit notarized, please use the declaration form contained in this packet.

2. Each notarization must be properly executed, including:a. Date of notarization (make sure it is later than the date of the signers’ signatures)b. Notary’s signaturec. Notary’s seal (rubber stamp)d. Date the Notary’s commission expires** Embosser optional

3. The Voter Services/Election Board office does NOT employ a Notary Public. Have yourpetitions notarized before you attempt to file.

4. Petitions may be filed in person or mailed:

Physical Address: Election Board One Montgomery Plaza 425 Swede Street 1st floor

Norristown, PA 19401

Mailing Address: Montgomery County Court House Election Board P.O. Box 311 Norristown, PA 19404-0311

Office hours: Monday through Friday, 8:00am to 4:30pm

WAIVER OF EXPENSE ACCOUNT REPORTING AFFIDAVIT

Since campaign finance reporting requirements do not apply to the offices of Judge of Election or Inspector of Election it is not necessary to complete this section.

DRAWING FOR BALLOT POSITION

If the number of candidates appearing on the ballot in the Primary Election is greater than the number of votes that may be cast for that office, a drawing for ballot position will be held to determine the order in which the names will appear. If, however, there is no contest, candidates’ names appear in alphabetical order. The drawing for ballot position will be held on March 17, 2021 at 10:00 am in the Commissioner’s Board Room in One Montgomery Plaza.

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Download Nomination Petitions - IMPORTANT NOTICE - Nomination petitions

must be printed as duplex (two-sided, front and back, head to head) on plain white 8 ½” x 11” (letter-size) paper. This requirement cannot be satisfied by printing each side of the nomination petition on a separate sheet of 8 ½” x 11” paper and affixing

the two sheets together.

PLEASE BE SURE TO PRINT THE

NEXT TWO PAGES (#’s 4 and 5 of packet)

DOUBLE-SIDED 8 ½ x 11 (LETTER-SIZE PAPER)

HEAD TO HEAD

PLEASE NOTE:

NOMINATION PETITIONS

WILL NOT BE ACCEPTED IF

PRINTED SINGLE-SIDED

PLEASE CALL OUR OFFICE

IF YOU HAVE ANY QUESTIONS

County and

of , and are registered

County to have the name of

of Residence is ,

, as a candidate for the Office of:

for a year term.

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(ELECTORAL DISTRICT IN WHICH THE NOMINATION OR ELECTION IS TO BE MADE)

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use

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and enrolled members of the Party or Policy, hereby petition the

County Board of Elections of

, whose(TYPEWRITE, PRINT OR WRITE PLAINLY THE ABOVE NAME AS YOU WISH IT TO APPEAR ON THE OFFICIAL BALLOT)

Profession, Business or Occupation is , Place

We, the undersigned, all of whom are qualified electors of

Signatures must be procured within the legal period for securing same; and this Petition must be filed in the office of the County Board of Elections on or

before the last day prescribed by law. EACH SIGNER MAY SIGN PETITIONS FOR AS MANY CANDIDATES FOR EACH OFFICE AS HE CAN VOTE FOR, AND NO MORE.

PETITION - 10 NAMES - MUNICIPAL - 2021

COMMONWEALTH OF PENNSYLVANIA

PETITIONTo have name of Candidate printed upon the Official Ballot for the Municipal Primary

SIGNERS ARE CAUTIONED TO AVOID THE USE OF DITTO MARKS

SIGNATURE OF ELECTORPRINTED NAME

OF ELECTOR HOUSE NO. STREET or ROAD MUNICIPALITY

DATE OF

SIGNING

ADDRESS WHERE REGISTERED AND ENROLLED

(TITLE OF OFFICE)

(WITH STREET, NUMBER (WHERE POSSIBLE) AND ZIP CODE)

be printed upon the Official Ballot of the Aforesaid Party in the said District, for the Municipal Primary for

the year

STATEMENT OF CIRCULATOR

I state that I am a qualified elector of the Commonwealth; that I am duly registered and enrolled as a member of the political

party designated in this nomination petition; that my residence is as set forth below; that the signers to the foregoing

petition signed the same with full knowledge of the contents thereof; that their respective residences are correctly stated

therein; that each signed on the date set opposite his or her name; that to the best of my knowledge and belief, the signers

are qualified electors, duly registered and enrolled members of the political party and of the political district designated in

this petition, and that they are residents in the County specified in number one below.

Further, I state the information set forth herein is true and correct to the best of my knowledge, information and belief, and

that this statement is made subject to the penalties of 18 Pa.C.S. § 4904 (relating to unsworn falsification to authorities).

1 ______________________________County of Petition-Signers’ Residence

2 ______________________________Printed Name of Circulator

3 ______________________________

4 ______________________________Number and Street Address of Circulator

5 ______________________________City, Borough or Twp. Zip Code

NOTE: THIS STATEMENT MUST BE COMPLETED AFTER ALL SIGNATURES HAVE BEEN OBTAINED.

Signature of Circulator

Before me, the undersigned authority in and for said State and County, personally appeared the undersigned, who, being duly sworn according to law, did depose and say that as a

candidate, he or she does not intend to form a political committee or to receive contributions or make expenditures in excess of Two Hundred Fifty Dollars ($250) during any reporting

period, that, as a candidate, he or she will keep records of contributions and expenditures as required by law; that, as a candidate, he or she will file reports as required by law if

nomination petition for judge of election or inspector of elections.

Each person filing any nomination petition shall pay, for each petition at the time of filing, a filing fee, and no nomination petition shall be accepted or filed, unless and until such filing fee ispaid by a certified check or money order or also by cash when filed with the county board. Whenever a petition is to be filed with the county board the person filing the same shall pay thefiling fee in cash or by certified check or money order to the county board. All moneys, certified checks and money orders paid on account of filing fees shall be transmitted by the county board to the county treasurer and shall become part of the General Fund. Filing fees shall not be refunded for any cause whatsoever. No filing fee shall be paid for any public office forwhich no compensation is provided by law, nor for any public officer in any borough, town or township (of the second class) nor any party officer except as provided nor for any

FILING FEES(SIGNATURE of NOTARY)

(STREET ADDRESS, POST OFFICE OF CANDIDATE)

(MUNICIPALITY and ELECTION DISTRICT of CANDIDATE)

(SIGNATURE of CANDIDATE)

THIS PETITION.

COMMONWEALTH OF PENNSYLVANIA COUNTY OF SS:

(STREET ADDRESS, POST OFFICE OF CANDIDATE)

Sworn to and subscribed before me this ________ day of ___________________, 20

NO

TAR

Y ST

AM

P

(SIGNATURE of NOTARY)

WAIVER OF EXPENSE ACCOUNT REPORTING AFFIDAVIT

contributions or expenditures exceed Two Hundred Fifty Dollars ($250). (Act No. 1980-127)

Sworn to and subscribed before me this _ day of ____ , 20

NO

TAR

Y ST

AM

P

(SIGNATURE of CANDIDATE)

(PRINTED NAME of CANDIDATE)

COMMONWEALTH OF PENNSYLVANIA

that he or she is eligible for said office; that he or she will not knowingly violate any election law, or any law regulating and limiting nomination and election expenses, and prohibiting

corrupt practices in connection therewith; that he or she is aware of the provisions of Section 1626 of The Pennsylvania Election Code requiring pre-election and post-election reporting

of campaign contributions and expenditures; and that he or she is not a candidate for an office which he or she already holds, the term of which is not set to expire in the same year as

the office subject to the affidavit. Also that he or she is not a candidate for nomination for the same office of anv political party other than the one designated in this petition . (Underlined portion not applicable to Candidates for the offices of School Director or Magisterial District Judge.)

Any candidate for local office shall file a statement of financial interests for the preceding calendar year with the governing authority of the political subdivision in which he or she

(TITLE OF OFFICE , PARTY and LENGTH OF TERM)

is a candidate on or before the last day for fiing a petition to appear on the ballot for election. A COPY OF THE STATEMENT OF FINANCIAL INTERESTS SHALL ALSO BE APPENDED TO

COUNTY OF SS:Before me, the undersigned authority in and for said State and County, personally appeared the undersigned, who, being duly sworn according to law, did depose and say that

his or her residence is as set forth below; that his or her election district is as set forth below; that the name of the office for which he or she consents to be a candidate is:

(MUNICIPALITY OF CANDIDATE)

(ELECTION DISTRICT OF CANDIDATE)

CANDIDATE'S AFFIDAVIT

(PRINTED NAME of CANDIDATE)

CIRCULATOR SHOULD

COMPLETE 1 - 5 BELOW

Bureau of Elections and Notaries 717-787-5280

CANDIDATE DECLARATION to be attached to CANDIDATE’S AFFIDAVIT

where notarized statement is not available

CANDIDATE DECLARATION - I declare that my residence, my election district and the title of the

office for which I desire to be a candidate are as contained in the attached document, that I am

eligible for said office, that I will not knowingly violate any election law or any law regulating

and limiting nomination and election expenses, and prohibiting corrupt practices in connection

therewith; that I am aware of the provisions of Section 1626 of the Pennsylvania Election Code

requiring pre-election and post-election reporting of campaign contributions and expenditures;

that unless I am a candidate for Judge of a Court of Common Pleas, the Philadelphia Municipal

Court or the office of school board in a district where that office is elective or the office of

magisterial district judge, my name has not been presented as a candidate by nomination

petitions of any other party for the same office; that if I am a candidate for any office of a

political party I am a registered and enrolled member of such party; that if I am a candidate for

Committee Delegate or Alternate Delegate to the National Convention the name of the

candidate to whom I am committed is as indicated on my nomination petition and that my

signature on the Delegate's Statement was affixed to each page of my nomination petition prior

to circulation of same; that I am not a candidate for an office which I already hold, the term of

which is not set to expire on the same year as the office subject to the accompanying affidavit.

I declare under penalty of perjury under the law of the Commonwealth of Pennsylvania that the foregoing is true and correct. Signed on the __________ (date) day of __________ (month), __________ (year), at ____________________ (county or other location, and state), __________ (country).

_____________________________________________ (printed name)

_____________________________________________

(signature)

(rev. 2/21)