California Code, Elections Code - ELEC § 6145

To the Secretary of State:

    I, Elections Official of the County of __________, hereby certify that I have examined the nomination papers to which this certificate is attached, of the candidate or uncommitted delegation, as the case may be, for purposes of qualifying for placement on the ballot at the ensuing presidential primary, that the number of names which I have not marked “not sufficient” is __________.

Dated this ______ day of ______, 20______.

______________,County Elections Official

(SEAL)

By _________________________, Deputy