We the undersigned registered voters of the city of ____________________,

(for municipal elections)

in the county of ____________________, State of Tennessee, (and members of the (for primaries) ______________________ Party), hereby nominate

(for municipal elections)

________________ ______________,

(name) (address)

______________ County as a candidate (for nomination) for the office of

(for primaries)

______________, ______________

(office) (division, part or district number)

to be voted in the election to be held on the ____________________ day of ____________________, ____________________. We request that such candidate’s name be printed on the official ballot.

This petition was issued by

______________,

(signature of administrator of elections, deputy or election commissioner)

______________

(date)

TO BE COMPLETED BY CANDIDATE

I hereby direct that my name appear on the official ballot as follows:

______________

PRINT NAME

FOR CANDIDATES REQUIRED TO BE AN ATTORNEY:

By my signature, I hereby certify that I

am licensed to practice law in this state. ______________

(signature of candidate)

SUPREME COURT REGISTRATION No. ____________________

NOMINATING SIGNATURES

(Must be registered voters who are eligible to vote to fill this office)