Mississippi Code
Chapter 31 - Public Improvement Districts
§ 19-31-9. Board of directors; membership, terms, election, voting by proxy; oath of office; filling of vacancy; quorum; officers; minutes; compensation

Statement of Intent
(Title) (Date)
Candidate for (insert name of district) Public Improvement District
I, (name of candidate as it will appear on the ballot),
(mailing address, street address, city, state, zip code, telephone number of the candidate), certify that I am a qualified voter, as defined in Section 19-31-5, Mississippi Code of 1972, of the (insert name of public improvement district) Public Improvement District in the State of Mississippi; and I do hereby declare my candidacy for Board of the (insert name of public improvement district) Public Improvement District at the election to be held on (insert date of election).
_______________
(Signature of candidate) (Date)
Received by_______________
Proxy for Election
1. Do constitute and appoint_______________(name), attorney and agent for me, and in my name, place and stead, to vote as my proxy for the election of members of the Board of Directors of the (name of district) Public Improvement District on (insert date), at the (insert voting location/facility name with street address); OR (only choose one)
2. Do hereby cast my vote for:_______________[print or type name of person being voted for - PLEASE NOTE THAT YOUR VOTE MUST BE FOR A QUALIFIED VOTER (AS DEFINED IN MISSISSIPPI CODE SECTION 19-31-5) OF THE DISTRICT. A QUALIFIED VOTER MEANS ANY LANDOWNER OF THE DISTRICT WHO IS AT LEAST EIGHTEEN (18) YEARS OF AGE OR AN AUTHORIZED REPRESENTATIVE OF THE LANDOWNER WHO IS ALSO AT LEAST EIGHTEEN (18) YEARS OF AGE.] to be elected as a member of the Board of Directors of the (name of district) Public Improvement District for a term beginning (date of term) and ending six (6) years from that date or until a successor is chosen.
(Insert name of district) Public Improvement District
I,_______________ , (name of qualified voter);_______________(street address);_______________(legal description);_______________(tax parcel identification number).
[NOTE: To be considered, this proxy must contain at least one (1) of either: the street address; legal description; or tax parcel identification number.]
I understand that I have the right to revoke this proxy at any time before the election. I understand that I have the right to be present in person at the election.
I have executed this proxy on (insert date).
_______________(Printed Name of Qualified Voter)
_______________(Signature of Qualified Voter)