1a — Nomination paper Office use only

Local governmentelection in EnglandDate received} Time received Initials No

“ELECTION OF GOUNGIEEORS / A COUNCILLORfor the

MARKET Rasen WOLDS electoral division/ward of the

county/district/London-bereugh of*Delete whicheveris inappropriate LINCOLNSHIRE Date ofelection: 6 MAY 804!

We,the undersigned, being local governmentelectorsfor the said *electoral division/ ward, dohereby nominate the under-mentioned person as a candidate at the said election

Candidate’s Details

Candidate’s surname B ULSARA Men

Other forenamesinfull Fa LRa KH

Commonly used surname(if any) Meecuey

Commonly used forenames(if any) FREDDIE Description (if any)Use no more than six words(see note 5)

HEAVENLY ARTISTS

Rebutes PaeTY

Signature

Electoral number

Print name Polling

|

ElectorDistrict Number

Proposer e Free Euvis PRestey

|

AR loi

Seconder „4. Hineho AMY WINEHOUSE AC |ouw

1b — Home address form Office use only

Local government elections in England Date received] Time received Initial No

“ELECTION OF GOUNGILLORS-/ A COUNCILLORforthe

MARKET Rasen) WoLPS “electoral division/ward-efthe

“county/distrietondon-borough of | m*Delete whicheveris inappropriate LiNCOLNSHIRE

Date of election: 6 ma+ 901]

You must complete Part 1

Only complete Part 2 if you do not wish your home address to be made public

Part 1: To be completed by all candidates in England

Full name of candidate FaRROKH BursAeA

| ANY ROAD , SOMEWHERE,Homeaddress(in full) NOLUOHERE y, SEI ANA

Qualifying address: Add your qualifying address, or qualifying addresses (in full) to each of therelevant qualifications below (you can complete more than one qualification).

Qualifcations that apply Address _

(a) | am registered as a local governmentelector í ANA ROAD,for the area of the “county/district/London-borough SOMEWHERE ynamed above NowHeee, SGi ana

(b) | have during the whole of the preceding 12 | Ant ROAD |months occupied as owneror tenant land or other SOMEWn ER €,premises in the area named above NowHaze , <GlanA

(c) my principal or only place of work during thepreceeding 12 monthshas beenin the

*county/district/London borough named above

(d) | have during the whole of the preceeding 12 il ANA ROAD,monthsresided in the *county/distriet-ertendon SOMEWH ECE,

bereugh named above NMowHere, SGaı AMA

Full name of the person whowill witness the |candidate’s consent to nomination form Kuet Cogai J

Full home addressof the person whowill witness X Cole .the candidate’s consent to nomination form

Part 2: To be completedonly if you do not wish your homeaddressto bemade public.

Note: Please submit this part (part 2) of the home address form with yournomination papers, even if your homeaddressis to be madepublic.

If you request that your homeaddressis not made public then your addresswill not appear onthe statement of persons nominated, notice ofpoll or the ballot paper. Instead the nameof therelevant area in which your homeaddressis situated (or country, if outside the UK), as explainedbelow,will appear on the statement of persons nominated, notice of poll and the ballot papers.

Statement: | require my home addressnot to be madepublic

The relevant area my home WEST LinoSesaddressis situatedin: : 2

(insert name of relevant area)

OR

My homeaddressis

situated outside the UK. Myhome addressis situatedin: (insert name of country)

Signature of candidate (only required where Part 2 above has been completed)

Candidate’s signature: FP B ulsarcı

Date: aa-03-a02) Deliver both Parts 1 and 2 with the nomination paperto the Returning Officer by no later than4pm onthelast day to deliver nominations

2 the nameofthe “relevant area” in which your home addressis situated (if your home addressis in the UK)e For home addresses in England:

- if the addressis within a district for which there is a district council, that district:- if the addressis within a countyin which there are nodistricts with councils, that

county;- if the addressis within a London borough,that London borough;- if the addressis within the City of London(including the Inner and Middle Temples),

the City of London; and- if the addressis within the Isles of Scilly, the Isles of Scilly

e For home addresses in Wales:- if the addressis within a county, that county;

if the addressis within a county borough, that county borougho For home addressesin Scotland:

- the local governmentarea in which the addressis situatedo For home addresses in Northern Ireland:

the local governmentdistrict in which the addressis situated

Note: The relevant area should be given in the format described above andis not the ward orparish, nor should the local authority name begiveninfull

Office use only1c — Candidate’s consent to nomination

Date received Timereceived Initials NoLocal governmentelections in England

*You must declare that you meetat least one ofthe listed qualification(s) below. To do this, strikethrough anythat do not apply. Any qualification(s) that apply must match the information given onyour home addressform.

Date ofelection: iec MAX aca)

| (nameinfull):

FaReRowH BuusarAhereby consent to my nomination as a MARxET Rasen *electoralcandidate for election as councillor for vierthe: WOLDS division/ ward.

of the *county/district/London

borough

of: LhNCOLNSHMIRAE

| declare that on the day of my nomination, | am qualified and that,if there is a poll on the day ofelection,| will be qualified to be so elected byvirtue of being on that day or those days aqualifying Commonwealthcitizen, a citizen of the Republic of Ireland or a citizen of a MemberState of the European Union, who hasattained the age of 18 years andthat

*a. | am registered as a local governmentelectorfor the area of the *county/district/Londonborough named above; or

“bp. | have during the whole of the 12 months precedingthat day, or those days, occupied asowneror tenantland or other premisesin the area named above; or

—county/distriet/tondor-boroughnamed-above-or-*d I have during the whole of those 12 monthsresidedin the *county/district or London borough

named above.

| declare that to the best of my knowledge and belief | am not disqualified for being elected byreason of any disqualification set out in, or decision made under, section 80 of the LocalGovernment Act 1972 or section 34 of the Localism Act 2011 (copies of which are printedoverleaf), and | do not hold a politically restricted post, within the meaning of Part 1 of the LocalGovernment and Housing Act 1989, undera local authority, within the meaning of that Part.

Date ofbirth: Signature: Date of consent:

oo foi

|

iqus

|

Fbuse 22\03|202\Witness: | confirm the above-mentioned candidate signed the declarationin my presence.

Witness (nameinfull): Kurt COBRAN

Witness's signature: K CoMo

p.1/4

Candidate’s consent to nomination [Local governmentelection in England

Local Government Act 1972

80. Disqualifications for election and holding office as memberof local authority

(1) Subject to the provisions of section 81 below, a person shall be disqualified for being elected orbeing a memberofa local authority if he —

(a)holds any paid office or employment(other than the office of chairman, vice-chairman,deputy chairman, presiding memberor deputy presiding memberor, in the caseofa localauthority which are operating executive arrangements which involve a leader and cabinetexecutive, the office of executive leader or memberof the executive) appointments orelectionsto which are or may be madeorconfirmed bythe local authority or any committee or sub-committee of the authority or by a joint committee or National Park authority on which theauthority are represented or by any person holding any suchoffice or employment; or

(b) is the subject of a bankruptcy restrictions order or an interim bankruptcyrestrictionsorder, or a debtrelief restrictions order under Schedule 4ZBof the Insolvency Act 1986; or

(c)[This has been removed and no longerapplies]

(d) has within five years before the day of election or since his election been convicted inthe United Kingdom, the ChannelIslands orthe Isle of Man of any offence and has had passedon him a sentence of imprisonment (whether suspendedornot) for a period of not less thanthree months without the option of a fine; or

(e) is disqualified for being elected or for being a memberof that authority underPart Illof the Representation of the People Act 1983.

(2) Subject to the provisions of section 81 below,a paid officerof a local authority who is employedunderthe direction of —

(a) a committee or sub-committee of the authority any memberof which is appointed onthe nomination of someotherlocal authority; or

(b) a joint board, joint authority, economic prosperity board, combined authority,jointwaste authority or joint committee on which the authority are represented and any memberofwhichis so appointed;

shall be disqualified for being elected or being a memberofthat other local authority.

(2AA) A paid memberof staff of the Greater London Authority whois employed underthe directionof a joint committee the membership of which includes —

(a) one or more persons appointed on the nomination of the Authority acting by theMayor, and

(b)one or more membersof one or more London boroughcouncils appointed to the committee onthe nomination of those councils,

shall be disqualified for being elected or being a memberof any of those London borough councils.

(2A) Subsection (2) above shall have effect as if the reference to a joint board included a referenceto a National Park authority.

(2B) For the purposesof this section a local authority shall be treated as represented on a NationalPark authorityif it is entitled to make any appointment of a local authority memberof theNational Park authority.

(3) Subsection (1)(a) shall have effect in relation to a teacherin a school maintained by the localauthority who doesnot hold an employmentfalling within that provision asit has effect inrelation to a teacher in such a school who holds such an employment.

(5) For the purposesof subsection (1)(d) above, the ordinary date on which the period allowed formaking an appealor application with respect to the conviction expiresor, if such an appeal orapplication is made, the date on which the appealor application is finally disposed of orabandonedorfails by reason of the non-prosecution thereof shall be deemedto be the date ofthe conviction.

p.2/4

Candidate’s consent to nomination Local governmentelection in England

81. Exception to provisions of section 80

(4) Section 80(2) and (3) above shall not operate so to disqualify —

(a) any personby reasonof his being a teacher, or otherwise employed,in a school or

other educationalinstitution maintained or assisted by a county council for being amemberof a district council by reason that the district council nominates membersof the education committee of the county council

Localism Act 2011

Section 34(4) describes how a person may be disqualified from standing in local government

elections underthis section. The remaining provisions of section 34 do notdirectly affect a

person's entitlement to stand for election.

34 Offences

(1) A person commits an offenceif, without reasonable excuse, the person—

(a) fails to comply with an obligation imposed on the person by section 30(1) or 31(2),

(3) or (7),(b) participates in any discussion or vote in contravention of section 31(4), or

(c) takes any steps in contravention of section 31(8).

(2) A person commits an offence if under section 30(1) or 31(2), (3) or (7) the person

provides information that is false or misleading and the person—

(a) knowsthat the information is false or misleading, or

(b) is reckless as to whetherthe information is true and not misleading.

(3) A person whois guilty of an offence underthis section is liable on summary conviction to

a fine not exceeding level 5 on the standard scale.

(4) A court dealing with a person for an offence underthis section may(in addition to any

other powerexercisable in the person's case) by order disqualify the person, for a period not

exceeding five years, for being or becoming (by election or otherwise) a memberor co-opted

memberof the relevant authority in question or any other relevant authority.

(5) A prosecution for an offence underthis section is not to be instituted except by or on

behalf of the Director of Public Prosecutions.

(6) Proceedings for an offence under this section may be brought within a period of 12

months beginning with the date on which evidence sufficient in the opinion of the prosecutor

to warrant the proceedings cameto the prosecutor's knowledge.

(7) But no such proceedings may be brought more than three years—

(a) after the commission of the offence, or

(b) in the case of a continuous contravention, after the last date on which the offence

was committed.

(8) A certificate signed by the prosecutor and stating the date on which such evidence came

to the prosecutor's knowledgeis conclusive evidenceof that fact; and a certificate to that

effect and purporting to be so signedis to be treated as being so signed unless the contrary

is proved.

p.3/4

Candidate’s consent to nomination Local government election in England

(9) The Local Government Act 1972 is amendedasfollows.

(10) In section 86(1)(b) (authority to declare vacancy where member becomes disqualifiedotherwise thanin certain cases)after “ 2000 ” insert “ or section 34 of the Localism Act 2011”

(11) In section 87(1)(ee) (date of casual vacancies)—

(a) after “2000”insert “ or section 34 of the Localism Act 2011 or”, and

(b) after “decision”insert “ or order ”.

(12) The Greater London Authority Act 1999 is amendedasfollows.

(13) In each of sections 7(b) and 14(b) (Authority to declare vacancy where Assembly

memberor Mayor becomesdisqualified otherwise thanin certain cases) after sub-paragraph(i) insert—

“(ia) under section 34 of the Localism Act 2011,”.

(14) In section 9(1)(f) (date of casual vacancies)}—

(a) before “or by virtue of” insert “ or section 34 of the Localism Act 2011 ”, and

(b) after “that Act” insert “ of 1998 or that section ”.

p.4/4

2 - Certificate of authorisation Office use only

Local government elections in Date received} Time received Initial No

England To accompanythe nomination of a candidate standing on behalf of a registered political party.

(Note: candidates standing on behalf of two or more parties require a certificate from each party

and each mustallow the sameregistered joint description to be used).

This certificate must be issued by the registered Nominating Officer of the party or by a personauthorised to sign on their behalf.

This certificate authorises the candidate to use a specific registered description or the name ofthe party as registered with the Electoral Commission, or to use ‘any registered description orthe party nameasregistered with the Electoral Commission’.

This authorised party nameor description can then beincluded by the candidate on thenomination form. It is this which will appear as their description on the ballot paper. Partynamesandregistered descriptions are listed on the Electoral Commission’s website(http://search.electoralcommission.org.uk).

Details of candidate to be authorised andthe allowed description/party name

Ward/division MAR<ET RASEN Date of

name: LOO LS S election: b MAY: 202)

The candidate A e |

(namein full): ARROKH ULSARA

HEAVENARMSTS REUNITEDNameofpolitical party: PARTY

Political party registered with the Electoral Commission

| herebycertify that the candidate = _STS

may include the following heaveuer ARK

registered description or party REUNI TES faerynamein their nomination form: Note:it is an offence to sign this form if you are not the party’s registered nominating officer

or authorised to do so bythe party's registered nominating officer

Signature of party’s registered Nominating e. ,Officer (or person authorised by the D Lo

registered Nominating Officer):

Name of person signing this form: DAVIS Bo LAN €

Date: ~ 22103) 202) This form must be delivered to the Returning Officer by no later than 4pm onthe last day to

deliver nominations.

3 — Requestfor a party emblem Office use only

Local government elections in Date received) Time received Initials, No

England

This form is for a candidate of a political party who is subject to a certificate of authorisation

and who wishes to have a party emblem printed on the ballot paper next to their name.

Party emblemsarelisted on the Electoral Commission’s website

(http://search.electoralcommission.org.uk).

This form must be signed by the candidate.

Candidate’s request for use of an emblem

MARICETT Date of |wie 5 m

Weard/division name: Rasen) lo: o AU 9202)

WOLDS

pada namein Fr 2 KH Bu Ls

| requestthat the ballot paper shall contain, against my name,the following registered

emblem (please identify which emblem if the party has registered more than one):

Emblem to be used

(Please use nameor Arefdescription as on the Electoral

Commission's website):

Candidate's signature: F Butsare

Date: 22103 Jaoz21 This form is only effective if delivered for a candidate standing on behalf of a political party to

the Returning Officer by no later than 4pm onthelast day to deliver nominations.

Candidates standing on behalf of more than onepolitical party and using a joint descriptionmay choose one emblem from one ofthe parties that you are standing for. Please indicatethe nameof the party and the emblem namein the ‘Emblem to be used’ box above.

4 — Notification of an election agent Office use only

Date received} Time received Initials No

Local governmentelections in England

Ward/division name Market Rasen DODS

Date of election: o (Mex BOD)

Candidate's notification of their election agent

I, (Candidate nameinfull): FARROKH BuLSAKA

Hereby declare that the name and address of my election agent to whichall claims, notices,legal process and other documents maybesentis:

Agent's name: DALID Bouse

Agent's addressin full (this may be an cor FAToffice or home address or could be a | Pe ollocal party office or otheroffice SOMEDAHIERXE

especially set up for the election): NoonAZe SG akRP

Candidate’s signature (or of person

authorised to act on behalf of LBcandidate): F “Aso

Date: 22 lo3l20>)

Confirmation of acceptance by election agent

| [agent named above] confirm my acceptance asthe election agent for the above namedcandidate.

| understand that | must carry out my duties according to law. | understand that there arepenaltiesif | fail to fulfil my duties according to law.

Agent's signature: D FourLe.

Date: 22102 lzo> |

Agent's other details in case of query (optional — will not be published)

Hometelephone: 01673 123123

Work telephone: 0-73 LSbustk

Mobile telephone: 01678 7289 7183

Email address: D. Bowie “D HARP.CO.UK

Return to the Returning Officer by no later than 4pm onthe last day to deliver nominations.