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Fill and Sign the Medical Certificate Format for Cara Adoption

Fill and Sign the Medical Certificate Format for Cara Adoption

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STATE OF ALASKA SUBSCRIBERS’ FORM NOMINATING PETITION CANDIDATE FOR GOVERNOR NAME: _______________________________________ OFFICE: GOVERNOR POLITICAL GROUP: ___________________________ (Candidate Name) (If no group, write “none”) We the undersigned, pursuant to AS 15.25.180, declare that: we are qualified voters of State of Alaska and we request that the candidate’s name be placed on the November *PRINTED NAME (Print Clearly) *SIGNATURE 20 General election ballot. *ALASKA RESIDENCE ADDRESS (i.e. house no. & street name, mile post & road name and AK City) *Last 4 SSN, Voter#, DOB, AK Driver’s License# or AK State ID # *DATE SIGNED 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 NOTE: Please attach all Subscribers’ pages to the “Nominating Petition” form. Signers’ names will be verified as qualified voters by the Division of Elections. *Voters should complete all columns for verification purposes. A20b (Rev. 1/28/09)

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