Statement of National Affiliation and Number of
National Convention Delegates for the Peace and
Freedom Party of California

To the Secretary of State:
Sacramento, California

You are hereby notified that the Peace and Freedom Party of California, by vote of its state central committee, has affiliated on the national level with the ______ Party. The address of the ______ Party’s principal office is ______, and its telephone number is _______.
You are further notified that the number of delegates to represent the Peace and Freedom Party of California in the next national convention of the ______ Party is ______.

Dated this ______ day of ______, 19__.

Chairperson of the State Central Committee of
the Peace and Freedom Party of California