2017 1017 Elections CANDIDATE Filing for Candidacy
ELECTION OFFICE DECLARATION OF CANDIDACY CANDIDATE NAME: ________________________________________ In this packet you will find the Declaration of Candidacy, Background Investigation Consent, and Candidate Voter Registry Request forms. Please fill out the forms by typing or printing in ink. Illegible forms or forms completed with pencil will be rejected. Incomplete forms or inaccurate forms will not be processed. QUALIFICATIONS FOR CANDIDACY: Principal Chief and Assistant Principal Chief Any enrolled member of the Osage Nation, who is at least thirty-five (35) years of age on the date of the election and has never been convicted of a felony, is eligible to become a candidate. Congress Member Any enrolled member of the Osage Nation, who is at least twenty-five (25) years of age on the date of the election and has never been convicted of a felony is eligible to become a candidate. Any person filing for office shall not be certified as a candidate if a felony conviction appears on a certified court record or proof of a separate bank account in the name of the candidate or candidate’s campaign is not provided upon filing. Please return the packet in its entirety and include the following when returning your packet to the Osage Nation Election Office: Copy of your Osage Nation Membership Card Copy of your Government Issued Photo ID Filing fee in the form of a Cashier’s Check or Money Order payable to the Osage Nation Election Office. No personal checks or cash will be accepted. Filing fees are as follows: o $500 for Principal Chief o $400 for Assistant Principal Chief o $300 for Congress Member
MUST INCLUDE ALL PAGES OF THIS FORM WHEN FILING
FOR ELECTION OFFICE USE ONLY RETURN THIS FORM BY: In Person: NOT a mailing address. 608 Kihekah Pawhuska, OK
FORMS WILL ONLY BE ACCEPTED IN PERSON FROM THE CANDIDATE FILING FOR OFFICE.
RECEPT #: _________________________ CASHIER’S CHECK/MONEY ORDER #: _______________ 1
ELECTION OFFICE DECLARATION OF CANDIDACY _____________________________ _________________ ___________ _________________________ Last Name First Name Middle Name Maiden, Suffix, Alias(es) ________________________________________________ Name as you wish for it to appear on the Official Ballot.
Due to ballot constraints, please use your First Name, Last Name, and Suffix ONLY. You may choose to use your Nickname in place of your First Name.
_________________ _________________ Enrollment Number Date of Birth
_______________________ _______________________ _____________________________________ Main Phone Number Alternate Number E-mail Address ___________________________________ _________________ ___________ ___________ _______ Physical Address City State County Zip ___________________________________ _________________ ___________ ___________ _______ Mailing Address, if different from above. City State County Zip Please circle the ONE office for which you wish to declare your candidacy: Principal Chief
Assistant Principal Chief
Congress Member
*FORM MUST BE SIGNED IN FRONT OF A NOTARY* I meet the applicable age, citizenship, voting qualification requirements prescribed by the Osage Nation Constitution, have not been convicted of a felony in any court within the United States and consent to a background check to verify my statement. I meet all qualifications for the office in which I declare my candidacy for. _________________________________ Signature
_________________________________ Date
State of __________ County of __________ Signed and sworn to before me on this _____ day of ____________, 20___. ____________________________ Signature of Notarial Officer My Commission Expires: __________
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ELECTION OFFICE BACKGROUND INVESTIGATION CONSENT _____________________________ _________________ ___________ _________________________ Last Name First Name Middle Name Maiden, Suffix, Alias(es) ___________________________________ _________________ ___________ ___________ _______ Physical Address City State County Zip ___________________________________ _________________ ___________ ___________ _______ Mailing, if different from above. City State County Zip ___________ _____ _____ _______________________ _______________________ Birthdate Age Sex Social Security Number Driver’s License Number _______________________ _______________________ _____________________________________ Main Phone Number Alternate Number E-mail Address Have you ever been convicted of, or do you have an ongoing prosecution for a felony?
YES
NO
If yes, please explain: ______________________________________________________________________ ________________________________________________________________________________________ Have you ever had any felony charges filed against you be expunged from your record?
YES
NO
If yes, please explain: ______________________________________________________________________ ________________________________________________________________________________________ I have carefully examined the information provided on this page and hereby certify that it is true and complete. I further understand that a background check will be processed with this information and all information will be kept confidential. If a candidate for office, I furthermore understand that if any information is false and a felony conviction is found, I forfeit my declaration as a candidate and all associated filing fees. _________________________________ Signature
_________________________________ Date
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ELECTION OFFICE VOTER REGISTRY REQUEST As a Candidate, the cost for the initial request for ONE LIST of voters in your choice of CD, Labels, or Hard Copy is included in the filing fee. Once this form is submitted during filing, please use the Election Office Voter Registry Request form included in your Candidate Packet for additional lists and updates that will be charged accordingly. _____________________________ _____________________________ Last Name First Name TYPE OF LIST All Osage Voters
CD $10
LABELS $10
*HARD COPY # of PGS _____ COST $_________ # of PGS _____ COST $_________ # of PGS _____ COST $_________
Election Voters (Lists will be split into Absentee and Walk In.) $10 $20 __2014 Primary __2014 General __2016 General __2017 Special Combined Election Voters for ALL Elections (List will ONLY provide $10 $20 names and addresses, will not be split into Absentee and Walk In, and will not list the election voted in.) Partial List (Charge is per List Requested) $5 $20 # of PGS _____ Describe List: ____________________________________________ COST $_________ List Updates $5 $20 # of PGS _____ New Members From: (Date) ___________ To: (Date) ___________ COST $_________ *HARD COPY COST: If more than 25 pages, 25 /page. *No personal checks accepted. Money Order, Cashier’s Check, or Cash $20 and under ONLY. I understand that the Osage Nation Election Board is required by law to furnish copies of current registration lists of names and addresses of registered voters in his or her possession to any qualified Osage Nation Voter upon request. I also understand due to the Privacy Program in place, some names and addresses of voters have been removed from these lists. By signing this request, you are agreeing to be a qualified Osage Nation Voter and acknowledge you are allowed this information, PROVIDED: That such list be used only for political purposes and shall not be used for commercial purposes. Use of a voter registry after a period of one (1) year from the date of the request is prohibited and is subject to punishment pursuant to Rule Two, Section 5(D) of the Osage Nation Election Board Rules and Regulations Governing Elections. If a complaint is made regarding the use of the Osage Nation Voter Registry for commercial purposes, the complainants will be referred to either the Osage Nation Police Department or Osage Nation Prosecutor. FOR ELECTION OFFICE USE ONLY
_________________________________________ Signature _________________________________________ Date
TOTAL COST: $__________ RECEIPT #: ________________________________________
RETURN THIS FORM BY: Mail: Osage Nation Election Office P.O. Box 928 Pawhuska, OK 74056 In Person:
NOT a mailing address. 608 Kihekah Pawhuska, OK
CASH AMOUNT: ____________________________________ CASHIER’S CHECK/MONEY ORDER #: ___________________ FORMS OF ID CHECKED: Membership Card Government Issued Photo ID
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ELECTION OFFICE CANDIDATE RELEASE OF INFORMATION The Osage Nation Election Office receives requests for contact information throughout the campaign period for candidates. In addition to giving out this information by request, we would also like to post the information to our website to allow for equal access. _____________________________ _____________________________ Last Name First Name
INITIAL next to which forms of contact information from PAGE 2 that you wish to be released: _____ E-mail Address _____ Main Phone Number _____ Mailing Address
By signing below, I give the Osage Nation Election Office permission to release my contact information selected above. _________________________________ Signature
_________________________________ Date
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MUST INCLUDE ALL PAGES OF THIS FORM WHEN FILING
FOR ELECTION OFFICE USE ONLY RETURN THIS FORM BY: In Person: NOT a mailing address. 608 Kihekah Pawhuska, OK
FORMS WILL ONLY BE ACCEPTED IN PERSON FROM THE CANDIDATE FILING FOR OFFICE.
RECEPT #: _________________________ CASHIER’S CHECK/MONEY ORDER #: _______________ 1
ELECTION OFFICE DECLARATION OF CANDIDACY _____________________________ _________________ ___________ _________________________ Last Name First Name Middle Name Maiden, Suffix, Alias(es) ________________________________________________ Name as you wish for it to appear on the Official Ballot.
Due to ballot constraints, please use your First Name, Last Name, and Suffix ONLY. You may choose to use your Nickname in place of your First Name.
_________________ _________________ Enrollment Number Date of Birth
_______________________ _______________________ _____________________________________ Main Phone Number Alternate Number E-mail Address ___________________________________ _________________ ___________ ___________ _______ Physical Address City State County Zip ___________________________________ _________________ ___________ ___________ _______ Mailing Address, if different from above. City State County Zip Please circle the ONE office for which you wish to declare your candidacy: Principal Chief
Assistant Principal Chief
Congress Member
*FORM MUST BE SIGNED IN FRONT OF A NOTARY* I meet the applicable age, citizenship, voting qualification requirements prescribed by the Osage Nation Constitution, have not been convicted of a felony in any court within the United States and consent to a background check to verify my statement. I meet all qualifications for the office in which I declare my candidacy for. _________________________________ Signature
_________________________________ Date
State of __________ County of __________ Signed and sworn to before me on this _____ day of ____________, 20___. ____________________________ Signature of Notarial Officer My Commission Expires: __________
2
ELECTION OFFICE BACKGROUND INVESTIGATION CONSENT _____________________________ _________________ ___________ _________________________ Last Name First Name Middle Name Maiden, Suffix, Alias(es) ___________________________________ _________________ ___________ ___________ _______ Physical Address City State County Zip ___________________________________ _________________ ___________ ___________ _______ Mailing, if different from above. City State County Zip ___________ _____ _____ _______________________ _______________________ Birthdate Age Sex Social Security Number Driver’s License Number _______________________ _______________________ _____________________________________ Main Phone Number Alternate Number E-mail Address Have you ever been convicted of, or do you have an ongoing prosecution for a felony?
YES
NO
If yes, please explain: ______________________________________________________________________ ________________________________________________________________________________________ Have you ever had any felony charges filed against you be expunged from your record?
YES
NO
If yes, please explain: ______________________________________________________________________ ________________________________________________________________________________________ I have carefully examined the information provided on this page and hereby certify that it is true and complete. I further understand that a background check will be processed with this information and all information will be kept confidential. If a candidate for office, I furthermore understand that if any information is false and a felony conviction is found, I forfeit my declaration as a candidate and all associated filing fees. _________________________________ Signature
_________________________________ Date
3
ELECTION OFFICE VOTER REGISTRY REQUEST As a Candidate, the cost for the initial request for ONE LIST of voters in your choice of CD, Labels, or Hard Copy is included in the filing fee. Once this form is submitted during filing, please use the Election Office Voter Registry Request form included in your Candidate Packet for additional lists and updates that will be charged accordingly. _____________________________ _____________________________ Last Name First Name TYPE OF LIST All Osage Voters
CD $10
LABELS $10
*HARD COPY # of PGS _____ COST $_________ # of PGS _____ COST $_________ # of PGS _____ COST $_________
Election Voters (Lists will be split into Absentee and Walk In.) $10 $20 __2014 Primary __2014 General __2016 General __2017 Special Combined Election Voters for ALL Elections (List will ONLY provide $10 $20 names and addresses, will not be split into Absentee and Walk In, and will not list the election voted in.) Partial List (Charge is per List Requested) $5 $20 # of PGS _____ Describe List: ____________________________________________ COST $_________ List Updates $5 $20 # of PGS _____ New Members From: (Date) ___________ To: (Date) ___________ COST $_________ *HARD COPY COST: If more than 25 pages, 25 /page. *No personal checks accepted. Money Order, Cashier’s Check, or Cash $20 and under ONLY. I understand that the Osage Nation Election Board is required by law to furnish copies of current registration lists of names and addresses of registered voters in his or her possession to any qualified Osage Nation Voter upon request. I also understand due to the Privacy Program in place, some names and addresses of voters have been removed from these lists. By signing this request, you are agreeing to be a qualified Osage Nation Voter and acknowledge you are allowed this information, PROVIDED: That such list be used only for political purposes and shall not be used for commercial purposes. Use of a voter registry after a period of one (1) year from the date of the request is prohibited and is subject to punishment pursuant to Rule Two, Section 5(D) of the Osage Nation Election Board Rules and Regulations Governing Elections. If a complaint is made regarding the use of the Osage Nation Voter Registry for commercial purposes, the complainants will be referred to either the Osage Nation Police Department or Osage Nation Prosecutor. FOR ELECTION OFFICE USE ONLY
_________________________________________ Signature _________________________________________ Date
TOTAL COST: $__________ RECEIPT #: ________________________________________
RETURN THIS FORM BY: Mail: Osage Nation Election Office P.O. Box 928 Pawhuska, OK 74056 In Person:
NOT a mailing address. 608 Kihekah Pawhuska, OK
CASH AMOUNT: ____________________________________ CASHIER’S CHECK/MONEY ORDER #: ___________________ FORMS OF ID CHECKED: Membership Card Government Issued Photo ID
4
ELECTION OFFICE CANDIDATE RELEASE OF INFORMATION The Osage Nation Election Office receives requests for contact information throughout the campaign period for candidates. In addition to giving out this information by request, we would also like to post the information to our website to allow for equal access. _____________________________ _____________________________ Last Name First Name
INITIAL next to which forms of contact information from PAGE 2 that you wish to be released: _____ E-mail Address _____ Main Phone Number _____ Mailing Address
By signing below, I give the Osage Nation Election Office permission to release my contact information selected above. _________________________________ Signature
_________________________________ Date
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