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PLEASE BE AWARE THAT THIS QUESTIONNAIRE WILL BE PUBLISHED.

The News-Herald
Election Questionnaire

Date questionnaire completed:

Office sought: Political party:

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Gender: Male / Female (circle one)

Name: __ Age:

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Home address:

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Length of residence in that community: Occupation: Marital status:

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Employer:

Campaign Web site:

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Name of spouse: __

Name and age of any children:

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Public office experience:


Political office held Municipality Years served Elected or appointed?

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Non-elected experience (committees, boards, etc.):

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Education:
Years Degree-Subject or Certificate

High School
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specific areas you'd like to change, address, improve orfurther foG(.(.r .0A.J

research, and how

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