Nomination Paper

Nomination Paper - Form 1
Ministry of Municipal Affairs
and Housing
Municipal Elections Act, 1996 (Sections 33, 35)
Instruction
Note
• A Nomination Paper may only be filed in person or by an agent;
• Please print or type information (except signatures).
it may not be faxed or e-mailed.
• It is the responsibility of the person being nominated to file a
complete and accurate nomination paper.
Nomination Paper of a person to be a candidate at an election to be held in the following municipality
Nominated for the Office of
Ward name or no. (if any)
Nominee's Name as it is to appear on the ballot paper (subject to agreement of the municipal clerk)
Last Name
Given Name(s)
Nominee's full qualifying address within municipality
Suite/Unit No.
Street No.
Street Name
City/Town
Mailing Address
Suite/Unit No.
Province
Postal Code
Province
Postal Code
Province
Postal Code
Same as qualifying address
Street No.
Street Name
City/Town
If nominated for school board, full address of residence within its jurisdiction
Suite/Unit No.
Street No.
Street Name
City/Town
Fax No.
Telephone No. (incl. area code)
Business
Home
Email Address
Declaration of Qualification
, the nominee mentioned in this nomination paper, declare that
I,
I am presently legally qualified, or would be presently legally qualified if I were not a member of the Legislative Assembly of Ontario or
the Senate or House of Commons of Canada, to be elected and to hold the office for which I am nominated and I make this solemn
declaration conscientiously believing it to be true and knowing that it is of the same force and effect as if made under oath.
Declared before me
at the
of
in the
of
this
day of
20
.
}
Signature of Clerk or Commissioner, etc.
Date Filed (yyyy/mm/dd)
Time Filed
Signature of Nominee
Nominee or Agent Initial
Signature of Clerk or Designate
Certification by Clerk or Designate
I, the undersigned clerk of this municipality, do hereby certify that I have examined the nomination paper of the aforesaid nominee filed
with me and am satisfied that the nominee is qualified to be nominated and that the nomination complies with the Act.
Signature
Date Filed (yyyy/mm/dd)
9499P (2013/11)
© Queen's Printer for Ontario, 2013
Disponible en français
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