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TO COUNTY AUDITOR OF ________________________ COUNTY


__________________________________, South Dakota




      I, __________________________________ of _________________________________________ _______________________________, South Dakota, declare that I reside and am a legally qualified voter in ____________ ward ______________________ precinct, of __________________________________ County, South Dakota, and a registered member of the LIBERTARIAN              Party and am a candidate

for Precinct Committee ________________________ of said Party and that I am desirous of serving in such position and if elected, will qualify and serve in such office.

      Dated this _____________day of_________________, 20_____.