Elec. Code, § 6365

The nomination paper for a candidate shall be in substantially the following form:

SECTION OF NOMINATION PAPER SIGNED BY VOTER ON BEHALF OF CANDIDATE

Section ____________ Page ____________

County of __________. Nomination paper for ____________ as presidential nominee of the Republican Party.

State of California County of ______ ⎱ ⎰ ss.

SIGNER’S STATEMENT

I, the undersigned, am a voter of the County of ____________, State of California, and am registered as intending to affiliate with the Republican Party. I have not signed the nomination paper of any other candidates for the same office, and further declare that I intend to support the nomination of the candidate named herein at the Republican Party presidential primary to be held on the ____________ day of ____________, 20____.

______ ______

Number______Signature______Printed name______Residence

______

1. ______

2. ______

3. ______

etc. ______

CIRCULATOR’S AFFIDAVIT

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 candidate named in the signer’s statement above as candidate for nomination by the Republican Party at its presidential primary election; 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.

(Signed)______Circulator______

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

______

(SEAL) Notary Public (or other official)