California Code, Elections Code - ELEC § 6587

County of ____________________. Nomination paper of group of candidates for election as delegates by the American Independent Party pledged to the candidacy of ____________________ as presidential nominee or expressing no preference, as the case may be.

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 intending to affiliate with the American Independent Party. I hereby nominate the following:

_________________________________________________________________________________________________

Number

Names

County

1.

_________________________________________________________________________________________

2.

_________________________________________________________________________________________

3.

_________________________________________________________________________________________

etc.

_________________________________________________________________________________________

(to such number as may be required) etc., as candidates for delegates to the American Independent Party's National Convention, to be voted for at the presidential primary to be held on the __________ day of __________, 20___. I have not signed the nomination paper of any other candidates for the same office, or of any candidate for the presidential preference portion of the primary ballot, and I further declare that I intend to support for nomination the candidates 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 the group of candidates named in the signer's statement above as candidates for nomination and election by the American Independent Party as delegates to represent the State of California in the party's next national convention; that all the signatures on this section of the nomination paper numbered from 1 to ___, inclusive, were made in my presence, that the signatures were obtained between ______, 20___, and ______, 20___, 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.

    I declare under penalty of perjury that the foregoing is true and correct.

(Signed) ________________________________________