California Code, Elections Code - ELEC § 8040

DECLARATION OF CANDIDACY

  I hereby declare myself a candidate for nomination to the office of __________ District Number __________ to be voted for at the primary election to be held __________, 20___, and declare the following to be true:

  My name is ______________________________________________________________________________________.

  I want my name and occupational designation to appear on the ballot as follows:  ________________.

  Addresses:

  Residence

_________________________________________________________________________________

_________________________________________________________________________________

  Business

_________________________________________________________________________________

_________________________________________________________________________________

  Mailing

_________________________________________________________________________________

_________________________________________________________________________________

  Telephone numbers:  Day __________ Evening __________

  Internet website:  _______________________________________________________________________________

  I meet the statutory and constitutional qualifications for this office (including, but not limited to, citizenship, residency, and party preference, if required).

  I am at present an incumbent of the following public office (if any) ____________________________.

  If nominated, I will accept the nomination and not withdraw, except as permitted by state law.

_____________________________________________

Signature of candidate

A candidate for voter-nominated office shall also complete all of the following:

(1) I hereby certify that:

  (a) At the time of presentation of this declaration, as shown by my current affidavit of registration, I have disclosed the following political party preference, if any:  .

  (b) My complete voter registration and party affiliation/preference history, from [10 years prior to current year] through the date of signing this document, is as follows:

Party Registration

County

Timeframe (by year)

_________________________________

________________

__________________________________________________

_________________________________

________________

__________________________________________________

_________________________________

________________

__________________________________________________

(2) Pursuant to Section 8002.5 of the Elections Code, select one of the following:

__________ Party Preference:  ________________________________________ (insert the name of the qualified political party as disclosed upon your affidavit of registration).

__________ Party Preference:  None (if you have declined to disclose a preference for a qualified political party upon your affidavit of registration).

Dated this ___ day of _____, 20___.

__________________________________________________

  Signature of candidate

A Notary Public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.

State of California

)

County of ___________________

) ss.

)

Subscribed and sworn to before me this ___ day of ______________, 20_____.

______________________________________________________________________

Signature of Notary Public (or other official)

     Notary Public Seal

Examined and certified by me this ______________ day of ______________, 20_____.

____________________________________________

County Elections Official

WARNING:  Every person acting on behalf of a candidate is guilty of a misdemeanor who deliberately fails to file at the proper time and in the proper place any declaration of candidacy in the person's possession which is entitled to be filed under the provisions of the Elections Code Section 18202.