EMAIL PETITION TO AL SEC. OF STATE

[Send an email to Beth.Chapman@sos.alabama.gov with a copy to me at rdshattuck@gmail.com.  In your email, put in the subject line "Ballot access petition for Robert Shattuck", copy and paste into the body of your email the language set out below, and fill  in your name, street address, city, county, precinct/voting place and date of birth information on your email.  You should send the email only if you are a registered voter in the 6th Congressional District (Spencer Bachus' district). You may find an interactive map of the 6th Congressional district here.  Precinct/polling place information may be found here.   ADDENDUM 3/12, 5:55 pm.  You should consider the deadline for sending an email to be 5 pm, Tuesday.]


[start your copying and pasting with "PETITION" and end with my name "Robert Shattuck" that is under the signature line]

PETITION FOR BALLOT ACCESS............................... PAGE _____ OF _____
INDEPENDENT CANDIDATE.................................... STATE OF ALABAMA

Pursuant to §17-9-3, Code of Alabama, 1975, I, the person named below, am a qualified elector in the Alabama 6th Congressional District and the County specified below, and as such hereby request and petition that the name of Robert Shattuck be certified as an Independent Candidate for the office of United States Representative from the Alabama 6th Congressional District and placed on the official printed ballot for said office in the General Election to be held on November 6, 2012.  I intend and desire that this electronic communication have the same legal effect as a physical document originally signed by me and filed with the Alabama Secretary of State.  Upon request I will provide an originally signed physical copy of this document.  I authorize Robert Shattuck to sign a physical copy of this email on my behalf and deliver the same to the Alabama Secretary of State.

Name:


Street address:


City:


County:


Precinct/voting place


Date of birth:




SIGNED ON MY BEHALF
BY ROBERT SHATTUCK


_______________________
Robert Shattuck