Name of County Extension Council
Street Address
City, State. Zip
123-456-7890
123-456-7890
E-MAIL name@missouri.edu
WEB extension.missouri.edu
PHONE
FAX
OFFICIAL BALLOT
This is your ballot for the election of members of the University of Missouri Extension Council of
County. Vote only for those nominees in the district in which you reside.
Place an X in the box by the name of the person of your choice.
DISTRICT I
Includes
, and
townships. (Describe district boundaries)
for two-year term
for two-year term
DISTRICT II
Includes (Describe district boundaries)
for two-year term
for two-year term
for one-year term
for one-year term
Eligible voters who reside in District II may vote for one candidate for a two-year term, and one for a one-year
term. (Where someone has resigned, this example might apply.)
NOTE: This form can be adapted to fit your particular situation. You may prefer to prepare a ballot for each
district where council members are to be elected instead of including all districts on one ballot. The statement,
"University of Missouri Extension does not discriminate on the basis of race, color, national origin, sex,
religion, age, disability or status as a Vietnam-era veteran in employment or programs" should be included on
the ballot.
University of Missouri, Lincoln University, U.S. Department of Agriculture and Local Extension Councils Cooperating
EQUAL OPPORTUNITY/ADA INSTITUTIONS