2016 GENERAL ELECTION CANDIDATE WITHDRAWAL (CAN-24) ‘State Form 40416 (F113 / 9-15) Indiana Etostion Division (103-8227, 3-8-2-25-4;3-85-105,$-8-5-145, 98-6135, 3-87-17, 587-20, 3-8-7-21,3-8-7-28) INSTRUCTIONS: This fois used by @ nominee chosen in a primary, nominated by peliion, or chosen by @ convention who wishes lo remove the ‘nominge’s name from the general elecon ballot. This frm lso used by a wit-in candidate who wishes to withdraw, DEADLINE: Except as others provided by law, hs withdrawal mustbe recived by te ofc with whom the Declareton of Candidacy or Pion of Nomination was fed rut cout clark ore Iiiana Election Dion) by NOON, daly 16, 2016, f nominatod at the primary election, party convention, or by peltion of nomination A win candidal or an ofice or than stool board) mus fo his form by NOON, July 15, 2016, For Schoo! Board offices: Aschool board candidal dung a wits candtae or hat oico) mus fle is form by NOON, August 29,2018, For Sinall Town ofies: A candidate wo flos a Geceation of conddany fora tov offe in a town witha population of lss than 3,600 may ihr by fing this statement by NOON, August 1, 2016, A candidate nominated by a tov convention must fle tis withdrawal ath tho ccut ‘court cork or town election boerd no later than NOON, 3 days ater he adjourament of the town convention, A candidate for city or tow office in a ‘munivpal elec year uses CAN-46 form to withdraw. To the Clerk of, Circuit Court, the Lake or Ti Elections and Registration, or Indiana Election Division: yecanoe County Board of CANDIDATE WITHDRAWAL the undersigned, Insert nario on previously fad candidacy withdraw as a candidate of the _ Republic Party for nomination to the off of Governae _ Distt (any) '6 bo vot'on sine general election to be held on November 8, 2016. eee (2) My residence address is: 4950 N. Meridian St. Indianapolis Compote Resins Adaross Wl Wa incor iy aoe (2) I request that you act under IC 3-8-7-17 or IC 9-6-7-28 to nally each appropriate counly election board to remove my ballot as the nominggroWho above menitoned part fr ti elie. rR 07 4/2016 ¢_317_4,_ 569.0709 Sears Dale Sire WAND Taephane Winber CERTIFICATE OF ACKNOWLEDGMENT ‘STATE OF INDIANA ) )ss: COUNTY OF ) Belore me, the undersigned, anolay public (or eer officer auihorized 0 lake ackrowiedgments) in an for (County andthe State of Inana, personally appeared b i ne the abovernamed condi acknowledged the execution of he above and foregoing instumont, Wiiness my hand and oficial sea this _| 2018. Notary Publi or Other Oficial Administering Oath according to 1@ 39-42. My Commission exis (pps ony fo Notary Pub: 2 CCouny of Residence.