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_Precinct <br />L- I <br />City of Little Canada <br />Minnesota <br />APPLICATION FOR JUDGE OR CLERK <br />OF ELECTION <br />.Registered <br />Mrs u s �, S 1` e? <br />Name? Mrs.) l� l <br />Miss) First Middle Last . <br />Address? ,_�%/� G 5 S -_- l� /� S Zip Code? 5 � l % Telephone? T may' y7. <br />Social <br />If -married, what was your maiden name? Security No. 7 .� �'� 6 - '9 2 <br />When were you born? <br />Month Day Year <br />Are you an employee of the U.S. Government, or of any state, county, city or <br />village government? Yes No Q <br />WHAT IS YOUR PARTY AFFILIATIO ? X DEMOCRATIC FARMER -LABOR <br />(Answer to above required by State Law) <br />REPUBLICAN <br />AMERICAN <br />OTHER <br />Have you ever been found guilty by any court of any violation of the law? Yes _ No Z <br />If so, give details <br />Have you any disease, infirmity, or deformity? Yes_ No X <br />If so, give details <br />Have you ever consulted a physician at any time during the past year for any <br />I disease or injury? Yes No _ <br />If so, give details / y % A/ / A/ <br />ANY FALSE STATEMENT ON THIS APPLICATION IS PUNISHABLE BY LAW <br />I certify that the statements made by me in this application are true, complete, <br />and correct to the best of my knowledge, and are made in good faith. <br />placation Received // -- / -' % ,7 <br />By <br />proved <br />SIGN HERE✓' <br />CLERK'S EXHIBIT NO. 1- � <br />MEETING-11-9-77 <br />