SECTION OF NOMINATION PAPER SIGNED BY VOTER ON
BEHALF OF GROUP OF CANDIDATES FOR DELEGATES
TO NATIONAL CONVENTION

Section ____________Page ____________

County of ______________. Nomination paper of group of candidates for election as delegates by the American Independent Party pledged to the candidacy of ____________ as presidential nominee or expressing no preference, as the case may be.

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 American Independent Party. I hereby nominate the following:

_____ Residence

city 

Number _____ Names _____ or town _____ County

 1.

 2.  

 3.

etc.

(to such number as may be required) etc., as candidates for delegates to the American Independent Party’s National Convention, to be voted for at the presidential primary to be held on the ____________ day of ____________, 20____. I have not signed the nomination paper of any other candidates for the same office, or of any candidate for the presidential preference portion of the primary ballot, and I further declare that I intend to support for nomination the candidates named herein.

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 group of candidates named in the signer’s statement above as candidates for nomination and election by the American Independent Party as delegates to represent the State of California in the party’s next national convention; 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.

(Signed) _____ Circulator _____