"AFFIDAVIT OF IMPECUNIOSITY”
Affidavit of Write-in Candidate for Mayor of Salt Lake City, Utah:
For the November 4, 2003 A.D., General Municipal Election:
Name: Lawrence Rey Topham Address:406 8th Avenue, Salt Lake City, Utah.
Phone Number: No Phone E-mail: lrtopham@hotmail.com or lrtopham@lycos.com
I, _____________Lawrence Rey Topham___________, do solemnly [swear] [affirm] that owing to my poverty, I am unable to pay the filing fee required by law.
Date: October 29, 2003 A.D.
Signature:_________________________________________________,Affiant.
Subscribed and sworn to before me on ______________________ (month/day/year)
_____________________________________________________________________
(Signature)
Name and Title of Officer Authorized to Administer Oath
________________________________________Seal_________________________
Notary Public or
Title of Public officer______________________________________________