California Elections Code Section 6586

The nomination paper for a candidate for the presidential preference portion of the 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 American Independent Party presidential 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 intending to affiliate with the American Independent Party. I hereby nominate ____ for the presidential preference portion of the American Independent Party`s presidential primary ballot, 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 candidate for the same office, or for any group of delegates, to the national convention of the party, and I further declare that I intend to support the candidate named herein. _________________________________________________________________ ----------------------------------------------------------------- Number Signature Printed name Residence ----------------------------------------------------------------- 1. __________________________________________________________ 2. __________________________________________________________ 3. __________________________________________________________ etc. __________________________________________________________ CIRCULATOR`S AFFIDAVIT I, ________, solemnly swear (or affirm) that I secured signatures in the County of ____ to the nomination paper of a candidate in the presidential preference primary of the American Independent 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. (Signed) ________________________ Circulator