Cal. 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 CaliforniaCounty 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____.


NumberSignaturePrinted nameResidence

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)