The News-Herald Date questionnaire completed: _______________

Election Questionnaire Office sought: _____________________________

Political party: _____________________________ Name: _____________________________________________________________________________ Age: __________ Date of birth: ___________________ Place of birth: _______________________ Home address: ______________________________________________________________________ Length of residence in that community: _______________ Twitter: ______________________ Facebook: ____________________ Campaign Web site: ___________________________________ Occupation: _________________________________________ Employer: _____________________ Business address: ____________________________________ Elected office experience: ______________________________________________________________ ___________________________________________________________________________________

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Non-elected office experience (boards, etc.): ______________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________

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Education (Please only list schools you’ve graduated from and list degrees if applicable): ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________

Marital status: ______________________ Name of spouse: _________________________________ Name and age of any children: __________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ Organizations: _______________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________

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Should you be elected, what are three specific areas you’d like to change, address, improve or further research, and how specifically would you go about it?: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________

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____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Whether for past accomplishments or future goals, why should voters elect you? ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ NOTE TO CANDIDATES: Please be aware that this questionnaire will be published.