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0F I ti 0f" It'\,r.tuYr z-Dj . (J'ee rztle 4) L-+*_**tF 0 II t NOMINATION PAPER A -k Election to the Legi sla tive A ssembly ot ?!.1.2:.1.2*..P. 82.Pf:..U... q\5 .f s^ OFF PART I OR PART iI BELOW WHICHEVER IS NOT APPLICABLE 0A PART I (Io be used by candidate set up by recognised politicui p*tu) \\o' I nominate as a candidate for eieclion to the Legislative Ass from the ''..'..''.'.''..,A trtuency Candiciate's name............ Father's,/ mother's/husband's namel . I-iisl her postal address His/ her name is entered at S.No.........,. .in Part No...........................of rhe electoral roil flor .......Assembly constiruency. My name ir..-..............., .and it is entered ar S.No.......,........., rn Parr r.{o the electoral roli for the .Assembly Constiruenry Date Signature of the proposer PART II We hereby_ nominate as candidate for election to the Legislative Assembly from the ,&*rne4tT CtT) .A ssembly Constiruency C a n di da t e's N am e . Sf f 1.. .. ...7. e.?.*..,......'r:. *:. \-rt t T '-Tzt t-n^ '-7at Father,s/moti1.er,s/husband,sname,..Lr.,,,k.,pr,,..T1.5.?., H,Y* waposral addre,uY(1P.9.+:..fI.9.(1p.r...(.9/*..!.ff.!.fJ..€?:.7..5.??.(.r9...?.:.'.fff 0 Sy v e e Yt*. P.<?.!.e. : (.. His/ hef name is entered at SI.No.t1.A........ /t: part No........ :.t.................of the electoral roll fur*.{s.e?.ft.gt.).7..C.{..2)...Arre*blv consdnrency I I I I Y''e cieclare that u,e are electors of this Asseri.:.-. :::.:-.-:-:r,: -: -r.-r names are :he electoral roil for rhis Assembiy constituenc)' as -r-*-:':- .: ,. : we ap signrtures below in token of subscribing to this nominatio:. - Particulars of the ro osers and their Si.no. Elector Roll No, of Proposer Full Name Part No. of S.No, in that part Electoral Roll I Z 3 + I g l- L/7 bo,qr> eeugyts 2. o/ //2 ots 74 b o ykr( Stvgtvt 3. e7 96 t/e 9o 3+.v9a o 4. 3+ 6s- D +cer a+D4 q\ o 5. 1 93 6. ey / 62- 7. a_7 eg4 8. R6 9z- 9. 0J- t6e iU N.B.- There should be ten electors of the constituency as proposers PART III I, the candidate mentioned in Part l/Part II (Strike out which is not applicable) assenr ro thrs nomination and hereby declare that- (a) I am a citizen of India and have not acquired the citizenship of any foreign State; (b) that I have completed.....*2. .V"ars of ug.; ISTzuKE OUT c(i) oR c(ii) BELOW WHICHEVER IS NOT APPLICABLEI I (c) (i) I am set up at this election .party, which is recognised I National Party/State State and that the symbol reserved for the above party be allotted oR (ii) I am set up at this election by the.Y"47/Ps.a.+p.9*p./ei,rnetrS{{iwhich is a regiqlered unrecognised political partylthat I am contesting this election as an independent candidate. (Strike out which is not applicable) and that the symbois I have chosen, in order ofpreference, are: (i).....4.?-c_fi- ...(ii)......... - ....... (iii). (d) rny name gnl my father's/mother's/husband's name have been correctly spelt out above in..€.y.9!.t{.#. (name of the tanguage); and (e) That to the best of my knowledge and beliei I am qualifieC and not aiso disqualified for being chosen to fill the seat in the Legislative Assembly of this Stlte. + I further declare that I am a member of the.. H/ *+emteltribe whieh is a scheduleci **casteitribe of the State of4rs.ry nstal.,.f.*ff# relation to...,*.ttpL*-..........(area) in that State 2 ',1\ I also declare that I have not been, and shall not be nominated as a candidate at the present general elqc-tiodthe bye-elections being held simultaneously, to lative qPi.raste(.f6f(Stute) ttom more than two Assembly constituenciis. oate.&.5./'Pi iQ... of W *+ Score out thc words not applicabte. N.B.-A "rccogniscd political pafiy" means a political party recognised by the Elcction Commission under the Election Symbols (Rescrvarion an<! Allotrnent) Order, 1968 in the Statc concemed. PART IIIA (To be filled by the candidate) ( l) Whether the candidate- (i) has been convicted- (a) ofany offence(s) under sub-section (l); or (b) for contravention of any law specified in sub-section (2) of section 8 of the Representation of the People Act, 1 95 I Yes,t t#/ (43 of l95l); or (ii) has been convicted for any other offence(s) for which he has been sentenced to imprisonment for two years or more. If the answer is "Yes", the candidate shall furnish the following information: (i) Case/First information report No./Nos. ...., ,Ny.f .,{?t!.',9n8(*.... , (ii) Potice station(s)f .olrtm/t(!.a/.e.Eistrict(s),4/.o.T.l?.?(Kor*State(s).M|9.tr1(.c.1.q.r.e- (iii) Section(s) of the concerned Act(s). and brief description of the offence(s) for which e L c he has been convicted . l1g L+7. +8 ft-*; . .. (iv) Date(s) of conviction(s).4/o.Z *er( r ca. elL (v) Court(s) which convicted the candidate.Ng?.ft?.Pk?4le-...........:............ (vi) Punishment(s) imposed [indicate period of imprisonment(s) and/or quantam of fine(s)l Na.7. ..* 2rhcca /e a (vii) Date(s) of release from prison . ..N.ef. *Pe/r (viii) Was/wei'e any appeal(s)/revision(s) filed against above conviction(s). r7.0... .YesA.lo* (ix) Date and particulars of the appeal(s)/application(s) forrevision filed..No.Z..*e.nhcq -..8./.e--.... (x) Name of the court(s) before which the appeal(s)/applicarion(s) for revision fi led. .A/p.l .. ft p. rl.c a Q /€-..... (xi) Whether the said appeal(s)/application(s) for revision has/have been disposed of or is/are pend ing. No.T..ft.fr. /l.<.+.r*/a- (xii) If the said appeal(s)/application(s) for revision-has/have been disposed of-- (b) Nafure of order(s) passed. .N.ql..ftee!1.?.4/*.-- 3 * (2) Whether the candidate is holding any office of profit under the Government of India or State Government?...Y.0.,. (YesA{o}--- -lf Yes, details of the office held.. ..A/.g'1....t?.tlt.+.*R(*. (3) Whether the candidate has been declared insolvent by any court?...L9. ffesalot' .IfYes,hashebeendischargedfrominsotvency.A/o;I,..'*,adr.e.o4e-* (4) Whether the candidate is under allegiance or adherence to any foreign country?..,.f9.... (Yes/Nof (5) Whether the candidate has been disqualified under section 8A of the said Act by an order of the Presiden tt ... l./9....(Yes/No!- -lf Yes, the period for which disqualified .,../).1'f .f?..C'cryg/L-* (6) Whether rhe candidate was dismissed for conuption or for distoyalfy while holding office under the Govemment of India or the Government of any State?....119.. lVesfN $c-'-' -tf Yes, the date of such dismissal.4lp/ .tUltgle/e-- (7) Whether the candidate has any subsisting contract(s) with the Government either in individual capacity or by trust or partnership in which the candidate has a share for iupply of any goods / to that Government or for execution of works undertaken by that Governmenl?...,1(q. (YesA'{o) -tf yes, with which Government and details of subsisting contract(s). ilqf. Aty'fgn/,?- (8) Whether the candidate is a managing agent, or manager or Secretary of any company or Corporation (other than a cooperative society) in the capital of which the Centrai/ Government or State Government has not less than twenty-five percent share?....419.- (Yes/nof -[f Yes, with which Government and the details thereof... Np|. Of..ke{e-.... (9) Whether the candidate has been disqualified by the Commission under section l0A of the said ectly'$. ffesAlo)--- -lf yes, the date of disqualifi catioin..N91..2f.fl::f?e- i Place'.tqH+ z l/7 Signature of the + PART IV be nomination paper. erial :01 nomination was delivered to > u, + preposer (Name). ",*{!:|lau,.) €ast is]r^t \ *Score out the word not applicable. Pradesh 6 € H I N INDIA I N 8 o,U ? q q+fl SH 01 AA 0951 \ ARUN rrr PARA 4.s(3.1) FORM 26 (SEE B RULE 4A) Affidavit to be furnished by the candidate before the returning officer for election to the Arunachal E Pradesh State Legislative Assembly (Name of the house) from l0-Seppa (East) (ST) Assembly Constituency (name of the constituency) B I , Shri Tapuk Taku, son/daughter/wife of Late Takap Taku, aged about 49 years resident of village : Kakukao PO/ PS: Seppa; District: East Kameng, Arunachal Pradesh candidate at the above election, do hereby solemnly $ affirm/state on oath as under:- ls amlam not accused any off-ence (s) punishable with imprisonment for two years or more appending n I of in case(s) in which a charge(s) has ,/have been framed by the court(s) of competent jurisdiction. B tf*," deponent is accused ofany such offence(s) he shall furnish the following information: g (i) Case/ First infbrmation report No.,4.,los Special. (vigilance)(T) Case No.03/2012, Special. (vigilance) (T) case No.O7 l2OL2 6 (ii) Police Station(s) Special Vigilance Distlict(s) Papumpare, State Arunachal Pradesh. (iii) Section(s) of the concerned Act(s) and short description of the offence(s) for which the candidate has been charged: Section(s) 120(b), 42O, 468 &471 tPC, R/W Section, 13(1)(c)(d) & 13(2) PC Act.
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