SOUTHLAND DISTRICT COUNCIL
BY-ELECTION
NOMINATION PAPER
MARAROA WAIMEA WARD MEMBER
(Notes for all candidates can be read on the back of the nomination paper)
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Mararoa Waimea Ward Member Nomination Paper
Southland District Council
Nominations must be in the hands of the Electoral Officer by 12.00 noon, Monday, 22 December 2014
A
CAN DID ATE to fill out after readin g importa n t informatio n on reve r se
I,
hereby consent to the above nomination and certify that I am qualified to be a candidate under
Section 25 of the Local Electoral Act 2001 and in terms of any other Act and that I am not disqualified
under Section 58 of the Local Electoral Act 2001. In particular I am a New Zealand Citizen and a
Parliam entary Elector (see notes on the reverse of thi s form ).
Address:
Home phone:
Mobile phone:
Work phone:
Fax:
Email:
I submit with this nomination
(please tick appropriate circles):
Evidence of Deposit ($200):
Photo:
Profile Statement:
I understand that, in not providing a profile or photo, the words “Profile/Photo no t supplied” will appear below my name in
the Profile Booklet that will be sent out with the Voting Document. All nomination documents must be submitted at
the same time.
My principal place of residence is:
(please tick appropriate circle)
WITHIN the
Mararoa Waimea Ward
NOT WITHIN the Mararoa
Waimea Ward
I wish my name to be shown on the voting document as:
In the public notice given under Section 65 of the Local Electoral Act 2001, I wish my affiliation to be shown as:
(To be left blank if the candidate does not wish to use any party/group affiliation)
Signature of
Candidate:
B
Date:
D D M M Y Y
NOMINATO RS to fill ou t
We the undersigned electors of MARAROA WAIMEA WARD of the Southland District Council hereby nominate (full
name please):
With his/her consent, as a candidate for the office of Mararoa Waimea Ward Member of the Southland District
Council.the election for which is to be held on Tuesday, 17 February 2015 .
Full name of
First Nominator:
Address:
Home phone:
Mobile phone:
Signature of
First Nominator:
Date:
D D M M Y Y
Date:
D D M M Y Y
Full name of
Second Nominator:
Address:
Home phone:
Signature of
Second Nominator:
Mobile phone:
Note:
Section 55(5) of the Local Electoral Act 2001 requires that this nomination form be available for public inspection at
Southland District Council’s office located at 15 Forth Street, Invercargill. Please note that candidate cont act details provided on this form
are placed on the Southland District Council website. Please advise at the time of lodging your nomination if there are cont act details that
you would not like to be published.
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B
EXTR A NO MINA TO RS t o fill out
Full name of
Third Nominator:
Address:
Home phone:
Mobile phone:
Signature of
Third Nominator:
Date:
D D M M Y Y
Date:
D D M M Y Y
Date:
D D M M Y Y
Date:
D D M M Y Y
Full name of
Fourth Nominator:
Address:
Home phone:
Mobile phone:
Signature of
Fourth Nominator:
Full name of
Fifth Nominator:
Address:
Home phone:
Mobile phone:
Signature of
Fifth Nominator:
Full name of
Sixth Nominator:
Address:
Home phone:
Signature of
Sixth Nominator:
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Mobile phone:
NOTES
1.
Candidates for the position of MARAROA WAIMEA WARD MEMBER do not need to live within the MARAROA WAIMEA WARD of the Southland District
Council but must be a New Zealand citizen and enrolled as a parliamentary elector.
2.
Both Nominators in the case of MARAROA WAIMEA WARD MEMBER candidates must live within the MARAROA WAIMEA WARD of the
Southland District Council and must be New Zealand citizens and enrolled as parliamentary electors.
3.
A candidate cannot nominate themselves for office.
4.
No person can be elected to a territorial authority if he/she is concerned or interested in contracts over $25,000 with that territorial authority.
This restriction is waived if prior approval from the Audit Office is obtained.
5.
A candidate may under Section 56 of the Local Electoral Act be nominated under a name which the candidate is commonly known provided that the
name will not cause offence to a reasonable person; be unreasonably long; include or resemble an official rank or title; cause confusion or mislead
electors.
6.
Where no affiliation is claimed, or an affiliation is disallowed by the Electoral Officer under Section 57 of the Act, nothing will be shown in the said public
notice against the candidate’s name, whether or not any other candidates have claimed an affiliation.
Under Section 121 of the Local Electoral Act 2001, any person is liable to a fine of up to $2,000 who:
(a)
Knowing themselves to be ineligible for election, consents to being nominated for election; or
(b)
Nominates any person as a candidate whom he/she knows to be ineligible for election; or
(c)
Not being the candidate signs any nomination paper knowing that they are not qualified to vote at the election.
7.
8.
A candidate may, in accordance with Section 61 of the Local Electoral Act 2001 and Clauses 26 to 29 of the Local Electoral Regulations 2001, provide a
candidate profile statement including a recent photograph for dispatch to electors with the voting documents. For further information about candidate
profile statements please refer to the Candidate Profile section of the Candidate Handbook for this election.
9.
Each nomination must be accompanied by the required deposit of $200 (inclusive of GST) or proof of an electronic deposit.
10.
Evidence of New Zealand citizenship may be requested at time of candidate nomination. Acceptable evidence includes New Zealand passport,
New Zealand birth certificate, New Zealand citizenship documentation.
11.
A nominator in the case of a candidate for city, district and regional council or a community board may be a residential or ratepayer elector.
12.
A candidate may stand for election for mayor, city/district council and a community/local board within the same territorial authority district, but may not
also stand for election to a regional council of which the territorial authority is part, i.e. a candidate may stand for either the city/district council/community
/local board or the regional council but not both. [Section 58 LEA].
13.
A candidate may not stand for more than one ward or more than one constituency of the same local authority or for more than one subdivision of a
community/local board area [Section 57A LEA]. However a candidate may stand for more than one community/local board within the same territorial
authority.
14.
Where a territorial authority has a mixed at large and wards system of representation, a candidate may not stand for councillor both in a ward and at
large for that territorial authority [Section 57B LEA].
15.
Nominations of candidate must be in the hands of the Electoral Officer, Southland District Council, 15 Forth Street, Invercargill, not later than
12.00 noon on Monday, 22 December 2014.
C: ELECTOR AL O FFIC ER to fill out
Received at the hour of:
on the
day of
20
1
4
Candidate Roll Number:
First Nominator Roll Number:
Nomination documents approved:
Second Nominator Roll Number:
Nomination paper:
Nomination documents approved:
Photo:
Deposit/proof of deposit:
Profile Statement:
Signature of Electoral Officer/
Deputy Electoral Officer:
CANDIDATE section completed
and signed
Place of residence:
Standing for other elections: Yes / No
Date:
FIRST NOMINATOR section
completed and signed
SECOND NOMINATOR section
completed and signed
D D M M Y Y
NOMINATION FORM
COMPLETED


Nominations must be in the hands of the Electoral Officer by 12.00 noon, Monday, 22 December 2014
All nomination documents must be submitted at the same time.
Return by:
Post to:
Southland District Council, PO Box 903, Invercargill 9840
Deliver to:
Southland District Council, 15 Forth Street, Invercargill
Southland District Council Lumsden Office, 18 Diana Street
Southland District Council Te Anau Office, 116 Town Centre
Email to: [email protected]
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Deposit to be paid into:
Account name:
Southland District Council
Bank: BNZ
Account number: 02 0924 0064987 00
Using the following deposit information:
Deposit reference eg: Mararoa Waimea Ward Member Code: (Your surname)
Or make payment directly at the Council office if you are returning this form by hand).
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