Election Code 10511 

The declaration of candidacy shall be in substantially the following form:

I, ______________________________, do hereby declare myself as a candidate for election to the office of _______________. (_________Initial here if the office for which you are running is for the balance of an unexpired term.) I am a registered voter.

If elected, I will qualify and accept the office of ___________and serve to the best of my ability. I request my name be placed on the official ballot of the district for the election to be held on the ______ day of _______,       

20___, and that my name appear on the ballot as follows:

____________________________________________________________________________________

My current residence address is

____________________________________________________________________________________

and my telephone number is ____________________________________________________________

I desire the following occupational designation to appear on the ballot under my name:

______________________________________________________________________________

                        (Print desired designation, if any, above)

This occupational designation is true and in conformance with Section 13107 or the Elections Code.

I am aware that any person who files or submits for filing a declaration of candidacy knowing that it or any part of it has been made falsely is punishable by a fine or imprisonment, or both, as set forth in Section 18203 of the Election Code.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Executed on __________________, 200___, at ________________(place)

___________________________________________(Signature of Candidate)