Elec. Code, § 6857

The nomination paper for a candidate for the presidential preference primary ballot shall be in substantially the following form:

SECTION OF NOMINATION PAPER SIGNED BY VOTER ON BEHALF OF PRESIDENTIAL PREFERENCE PRIMARY CANDIDATE

Section ____________ Page ____________

County of __________. Nomination paper of a presidential preference candidate for the Green Party presidential preference primary ballot.

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 preferring the Green Party. I hereby nominate ____________ for the presidential preference portion of the Green Party’s presidential primary ballot, to be voted for at the presidential preference primary 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. ______

etc.

CIRCULATOR’S DECLARATION

I, ________, affirm all of the following: 1. That I am 18 years of age or older. 2. That my residence address, including street 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 a candidate in the presidential preference primary of the Green Party, 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] ______________________________ Circulator [Printed Name] _____________________________