x . . . . . . . . . . . BIND HERE . . . . . . . . . . .

PETITION
We, the undersigned, registered and duly qualified voters residing within the 5 th Ward of the City of Chicago, County of Cook, State of Illinois, do hereby
petition that the following named person residing at the following address be a candidate for election to the office hereinafter specified to be voted for at
the February 26, 2019 Municipal General Election.

Candidate’s Name Candidate’s Address Office

1533 East 65th Street 5 Ward Alderman
th

GABRIEL PIEMONTE Chicago, Illinois 60637 Chicago, Illinois

Signature Printed Name Residence Address City, State,

House # and Street, or RR# County
1. Chicago, Illinois
Cook County

2. Chicago, Illinois
Cook County

3. Chicago, Illinois
Cook County

4. Chicago, Illinois
Cook County

5. Chicago, Illinois
Cook County

6. Chicago, Illinois
Cook County

7. Chicago, Illinois
Cook County

8. Chicago, Illinois
Cook County

9. Chicago, Illinois
Cook County

10. Chicago, Illinois

Cook County

Circulator’s Affidavit
State of Illinois )
) ss.
County of _________ )

I, (Circulator’s Name), being first duly sworn, do hereby certify that I reside at

(Residence Address), in the City/Town/Village (circle one) of ,

Zip Code , County of , Illinois, that I am 18 years of age or older (or 17 years of age and qualified to vote in Illinois),
that I am a citizen of the United States, and that the signatures on this sheet were signed in my presence, not more than 90 days preceding the last day for
the filing of the petitions, and are genuine, and that to the best of my knowledge and belief the persons so signing were, at the time of signing the
petitions, duly registered and qualified voters of the 5th Ward of the City of Chicago, Cook County, Illinois, and that their respective residence addresses are
correctly stated, as set forth above.

Signature of Circulator

Signed and sworn to (or affirmed) by before me this day of , 2018.

(Circulator’s Name) (Day) (Month)

(seal)
Signature of Notary

Sheet No. ___