California Code, Elections Code - ELEC § 8409

County of _______________. Nomination paper of ______, candidate for the office of ______.

State of California

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ss.

County of ____________

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    I, undersigned, am a voter of the County of ____________________, State of California. I hereby nominate __________, who resides at No. ______, __________ Street, City of __________, County of __________, State of California, as a candidate for the office of __________ to be voted for at the election to be held on the ______ day of __________, 20___. I have not signed the nomination paper of any other candidate for the same office.

_________________________________________________________________________________________________

_________________________________________________________________________________________________

Number

Signature

Printed Name

Residence

_________________________________________________________________________________________________

1.

_____________________________

_____________________________

_____________________________

2.

_____________________________

_____________________________

_____________________________

3.

_____________________________

_____________________________

_____________________________

4.

_____________________________

_____________________________

_____________________________

5.

_____________________________

_____________________________

_____________________________

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 ______ as candidate for the office of __________; that the signatures were obtained between ______, 20___, and ______, 20___; that I saw all the signatures on this section of the nomination paper being signed and that, to the best of my information and belief, each signature is the genuine signature of the person whose name it purports to be.

* * *

(Signed) __________________________________________________

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

___________________________________________________________

(SEAL)

Notary Public (or other official)