California Code, Elections Code - ELEC § 6108

County of _______________. Nomination paper of a candidate or uncommitted delegation for the presidential primary ballot.

State of California

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ss.

County of ____________

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    I, the undersigned, am a voter of the County of ____________________, State of California, and am registered as affiliated with the Democratic Party. I hereby nominate __________ for the presidential primary to be held on the ______ day of ______, 20___. I have not signed the nomination paper of any other candidate or uncommitted delegation, and I further declare that I intend to support the candidate or uncommitted delegation named herein.

_________________________________________________________________________________________________

_________________________________________________________________________________________________

Number

Signature

Printed name

Residence

_________________________________________________________________________________________________

1.

_________________________________________________________________________________________

2.

_________________________________________________________________________________________

3.

_________________________________________________________________________________________

etc.

_________________________________________________________________________________________

_________________________________________________________________________________________________

    I, _______________, solemnly swear (or affirm) all of the following:

    1. That I am 18 years of age or older.

    2. That my residence address, including street and number, is

.

    [If no street or number exists, a designation of my residence adequate to readily ascertain its location is

_________________________________________________________________________________________.]

    3. That I secured signatures in the County of ____________________ to the nomination paper of a candidate or uncommitted delegation for the presidential primary ballot named in the signer's statement above;  that all the signatures on this section of the nomination paper numbered from 1 to ___, inclusive, were made in my presence, and that to the best of my knowledge and belief each signature is the genuine signature of the person whose name it purports to be. The signatures were obtained between ____________, 20___, and ____________, 20____.

(Signed) __________________________________________________

Subscribed and sworn to before me this ____ day of ____, 20____.

___________________________________________________________

(SEAL)

Notary Public (or other official)