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• <br />N <br />Title of individual completing this application: Deputy Clerk /Election Liaison <br />Name of individual completing this application: <br />za2'A uuar <br />w <br />Name of the County (s) in which the political subdivision resides in: <br />0 <br />:uoisTATpgnS pomod Jo mum 'Z <br />sa )Ju7 ouT7 30 ( :TD <br />Date Application Was Submitted: <br />:suolisana uoisNDizaaV <br />See last page of this document for contact information. <br />C b o b <br />el) O ►t b n <br />0 1:1 O A <br />1Th O AD "'t <br />eD et et- ft Cl. rD O A <br />,,,-i• e a ►n <br />r* <br />IS c� �. n <br />.. Fir, <br />V) p a <br />O <br />n 0 y <br />01 CD C �' oft <br />04 g <br />0 y IM. C <br />4 = y a <br />el, n A O <br />itz <br />C' O fr* <br />tD <br />CT R' `. <br />cip <br />cn AD o p <br />n <br />I D <br />tD <br />AZ <br />0 OC: CA <br />b E. <br />,-t- n <br />a� ry 4 <br />r.t <br />04 <br />b n p <br />p O p• <br />.1 y eD <br />eD <br />: b a co <br />CD °. 1.0 <br />et- fa <br />A O iv <br />O n <br />A� a. <br />0 <br />AD O C <br />D M <br />C' <br />O <br />scow nitsui lnaauao <br />