Candidate Pre-filing Form

Official Candidate Pre-filing Form

Republican Party of Virginia
Montgomery County Party Canvass
Official Candidate Filing Form
For
Montgomery County Board of Supervisors
To be elected at the
Montgomery County Party Canvass- May 20, 2017
[Pre-filing deadline: April 7, 2017, 5:00 pm EST]

I hereby file to seek the Republican nomination for Board of Supervisors in the following district (circle one):

District A District C District D

Must be completed in full.

Print Full Name: _____________________________

Name as it is to appear on the ballot: ____________________________

Legal Residence (Post Office box or general delivery will NOT be accepted):

___________________________________________________________________

Phone: _______________________ Email: __________________________

Filing Fee: $200.00

Voluntary Contribution: _______________
(To defray costs of the party canvass and support Montgomery County Unit Committee)

Total Enclosed: $_____________ All filing fees are nonrefundable.

By my signature below, in accordance with the Qualifications for Participation set forth in the Plan of Organization for the Republican Party of Virginia, I do hereby state my intent to support the Montgomery County Republican nominee in the November 7, 2017 General Election. I further agree to remove all campaign signs and materials from the balloting stations at the conclusion of the party canvass, and not later than 5:00pm on May 20, 2017.
_____________________________________ _______________________
Signature of Candidate Date

Completed and signed form, along with a check or money order payable to: Montgomery County Republican Committee must be submitted no later than 5:00PM on Friday April 7, 2017 and delivered to Jeff Richardson, care of Chris Tuck, PC Law Office located at 811 Triangle Street, Blacksburg, VA 24060 which must be received not later than 5:00 pm, Eastern Standard Time, Friday, April 7, 2017 (the “pre-filing deadline”). Candidates may also contact Jeff Richardson directly for in-person delivery of pre-filing form and $200 filing fee at: jeffrichardson721@ymail.com.. Actual receipt is required. Postmarks will not govern. Incomplete or modified forms, and/or filing forms accompanied by an invalid check, will be returned, and the individual will be deemed to have not filed for candidacy. Mr. Richardson can be contacted at jeffrichardson721@ymail.com.

Paid for and Authorized by Montgomery County Republican Committee, Robert Dickenson, Chairman.