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* 1. Office you are seeking (Please include township, borough or school district)

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* 2. Name

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* 3. Age

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* 4. Address

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* 5. Education

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* 6. Occupation

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* 7. What is your previous government or elected office experience?

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* 8. Why Are You Seeking This Office?

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* 9. Given one guaranteed accomplishment in office, what would you choose?

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* 10. Please complete and return to ebrandt@pottsmerc.com by Thursday, Oct. 21, with a .jpg photograph, to be guaranteed inclusion in an election preview article.

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