California Code, Elections Code - ELEC § 6787

    Nomination paper of group of candidates for election as delegates by the Peace and Freedom Party pledged to the candidacy of __________ as presidential nominee, or expressing no preference, as the case may be.

State of California

}

ss.

County of ____________

}

    I, the undersigned, am a voter of the County of ______, State of California, and am registered as affiliated with the Peace and Freedom Party.  I hereby nominate the following:

_________________________________________________________________________________________________

_________________________________________________________________________________________________

Number

Names

County

_________________________________________________________________________________________________

 1.

_________________________________________________________________________________________

 2.

_________________________________________________________________________________________

 3.

_________________________________________________________________________________________

etc.

_________________________________________________________________________________________

(to the number as may be required) as candidates for delegate to the national convention of the ______ Party, with which the Peace and Freedom Party of California is affiliated on the national level, to be voted for at the presidential primary to be held on the ______ day of June, 20 ___.  I have not signed the nomination paper of any other group of candidates for delegates to the national convention or of any candidate for the presidential preference portion of the primary ballot.

_________________________________________________________________________________________________

_________________________________________________________________________________________________

Number

Signature

_________________________________________________________________________________________________

 1.

_________________________________________________________________________________________

 2.

_________________________________________________________________________________________

 3.

_________________________________________________________________________________________

etc.

_________________________________________________________________________________________

_________________________________________________________________________________________________

    I, __________, 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 Peace and Freedom Party as delegates to represent the Peace and Freedom Party 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.

    Executed at ______, California, this ______ day of ______, 20___.

(Signed) __________________________________________________

(Printed name) ____________________________________________