Escolar Documentos
Profissional Documentos
Cultura Documentos
MUNICIPAL
SIGNATURE
} ss.
TITLE
Date:
I, of
Ward or Councilmanic District
Full Term
Short Term
I will accept the office in the event of my election to this office at the election to be held on
November 6, 2012
and I desire the following designation to appear on the ballot under my name:
(Print or type your principal profession(s), vocation(s), or occupation(s), in 3 words or less; or the name of the elective public office you hold or Incumbent. If you leave this space blank, no designation will appear on the ballot.)
SIGNATURE OF NOMINEE
)
DAY TELEPHONE NUMBER
)
EVENING TELEPHONE NUMBER
)
FAX
EMAIL ADDRESS:
ss.
SIGNATURE OF NOMINEE
day of
, 20
MUNICIPAL
, hereby
November 6, 2012
DATE OF ELECTION
NAME
RESIDENCE ADDRESS
NO. & STREET CITY NO. & STREET CITY NO. & STREET CITY NO. & STREET CITY NO. & STREET CITY NO. & STREET CITY NO. & STREET CITY NO. & STREET CITY NO. & STREET CITY NO. & STREET CITY NO. & STREET CITY NO. & STREET CITY NO. & STREET CITY NO. & STREET CITY NO. & STREET CITY NO. & STREET CITY ZIP ZIP ZIP ZIP ZIP ZIP ZIP ZIP ZIP ZIP ZIP ZIP ZIP ZIP ZIP ZIP
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
SIGN PRINT SIGN PRINT SIGN PRINT SIGN PRINT SIGN PRINT SIGN PRINT SIGN PRINT SIGN PRINT SIGN PRINT SIGN PRINT SIGN PRINT SIGN PRINT SIGN PRINT SIGN PRINT SIGN PRINT SIGN PRINT
IMPORTANT! Turn to reverse side for signatures spaces 17-30 and Affidavit of Circulator, which must be filled out. OFFICE USE ONLY NO. OF VALID SIGNATURES
MUNICIPAL
17 18 19 20 21 22 23 24 25 26 27 28 29 30
SIGN PRINT SIGN PRINT SIGN PRINT SIGN PRINT SIGN PRINT SIGN PRINT SIGN PRINT SIGN PRINT SIGN PRINT SIGN PRINT SIGN PRINT SIGN PRINT SIGN PRINT SIGN PRINT
ss.
obtained between
, 20
, and
, 20
that I circulated this petition and I witnessed the signatures on this section of the nomination papers being written; 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.
My residence and voting address is I certify under penalty of perjury under the laws of the State of California that this declaration is true and correct. Executed on Signature of Circulator
(INCLUDE FIRST, MIDDLE AND LAST NAME)
, 20
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