Receipt for Nominat on Papers — City of Chicago a For the February 22, 2011 Municipal General Election oe Board of Election Commis: ioners for the City of Chicago Lance Gough, Executive D vector Name of Candidate GQEC2 gE CAROT Nit Address _ Dot S MAR SHALe Biv a CHIMmGo 1k £062.% a Office on Pecition [ek] alderman — ward (2: {_|Mayor city Clerk City Treasurer Filing Ticket Number Are these items included? (Mark Yes or No) Yes No xX Statement of Candidacy Receipt for Statement of Econ. raic Interests x Loyalty Oath (This document s optional.) x | Are the Nominating Papers be 4.4? Ifyes, describe how they « « bound: Was Election Board photo tak »» of Nominating Papers? Number op Last Page of Petition | Received From (72. idgwir _Phonel, Address _ ur Mawsuan | Phone? (ifavailable) Fax Number _ fe Email i é i enol a hes CO ignature of person submitting petition fata. de [ abate aps hs For Election Boayd Emp yee to Complete Notice of Campaign Finance & Disclosure Requirements Gisun: _A”___In Person _By Mail 7 Received By ae ye ___Date_ Vy iso ‘eo Original: Keep with Petition Oo Copy: For Candidate