APPLICATION FOR ELECTION
SPECIAL DISTRICT DIRECTOR
I, the undersigned, swear or affirm that I was born on ...., (year); that I have been a resident of ....district since ...., residing at ....; that I am an elector or landowner (check which one for eligibility) of said district and I do hereby request that my name, ...., be printed on the ballot of the formation (or other) election to be held on ....day of ...., (year) as a candidate for the office of director for a term of ....years. I hereby declare that if I am elected, I will qualify for the office.
Dated ....
................Signature of Candidate
W.S. 22-29-110