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CANDIDATE DECLARATION FORM I a resident and registered voter of the county of and the state of Missouri do announce myself an independent candidate for the office of to be voted for at the general election to be held on the 4th day of November 2008 and I further declare that if nominated and elected I will qualify. I further declare that I have no outstanding campaign disclosure reports due from any prior elections that I have never been found guilty of or pled guilty to a felony or misdemeanor under the federal laws of the United States of America and that I have never been convicted of or found guilty of or pled guilty to a felony under the laws of Missouri. Name as it is to appear on the ballot Residence Address City State Zip Mailing Address if different I hereby swear or affirm that the information contained in the foregoing declaration of candidacy is to the best of my knowledge true. Signature of Candidate Subscribed and sworn to before me the day of 2008. SEAL 115. 327 115. 348 115. 350 130. 071RSMo 2000 Rev* 3/07 Signature of election official or other officer authorized to administer oaths. I further declare that I have no outstanding campaign disclosure reports due from any prior elections that I have never been found guilty of or pled guilty to a felony or misdemeanor under the federal laws of the United States of America and that I have never been convicted of or found guilty of or pled guilty to a felony under the laws of Missouri. Name as it is to appear on the ballot Residence Address City State Zip Mailing Address if different I hereby swear or affirm that the information contained in the foregoing declaration of candidacy is to the best of my knowledge true. Name as it is to appear on the ballot Residence Address City State Zip Mailing Address if different I hereby swear or affirm that the information contained in the foregoing declaration of candidacy is to the best of my knowledge true. Signature of Candidate Subscribed and sworn to before me the day of 2008. SEAL 115. 327 115. 348 115. Signature of Candidate Subscribed and sworn to before me the day of 2008. SEAL 115. 327 115. 348 115. 350 130. 071RSMo 2000 Rev* 3/07 Signature of election official or other officer authorized to administer oaths. I further declare that I have no outstanding campaign disclosure reports due from any prior elections that I have never been found guilty of or pled guilty to a felony or misdemeanor under the federal laws of the United States of America and that I have never been convicted of or found guilty of or pled guilty to a felony under the laws of Missouri. Name as it is to appear on the ballot Residence Address City State Zip Mailing Address if different I hereby swear or affirm that the information contained in the foregoing declaration of candidacy is to the best of my knowledge true. Signature of Candidate Subscribed and sworn to before me the day of 2008. SEAL 115. 327 115. 348 115. Name as it is to appear on the ballot Residence Address City State Zip Mailing Address if different I hereby swear or affirm that the information contained in the foregoing declaration of candidacy is to the best of my knowledge true. Signature of Candidate Subscribed and sworn to before me the day of 2008. SEAL 115. 327 115. 348 115. 350 130. 071RSMo 2000 Rev* 3/07 Signature of election official or other officer authorized to administer oaths.

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