California Statutes § 10226.3 Declaration of candidacy form

(a) The declaration of candidacy by a candidate shall be substantially as follows:

DECLARATION OF CANDIDACY

I hereby declare myself a candidate for nomination to the office of ________ District Number ________ to be voted for at the municipal election to be held ________, 20__, and declare the following to be true: My name is. I want my name and occupational designation to appear on the ballot as follows: ______________________________________.

Addresses: Residence Business Mailing

Telephone numbers: Day _________ Evening _________

Internet website:_______________________________________

I meet the statutory and constitutional qualifications for this office (including, but not limited to, citizenship, and residency).

I am at present an incumbent of the following public office

(if any) __________.

If nominated, I will accept the nomination, and if elected, I will accept the office.

Signature of candidate

A Notary Public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.

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Subscribed and sworn to before me this ___ day of ________, 20____.

Signature of Notary Public (or other official) Notary Public Seal

Examined and certified by me this ________ day of ________, 20____.

County Elections Official

WARNING: Every person acting on behalf of a candidate is guilty of a misdemeanor who deliberately fails to file at the proper time and in the proper place any declaration of candidacy in the person's possession which is entitled to be filed under the provisions of the Elections Code Section 18202 .

(b) At the discretion of the elections official, a candidate for any office whose voter registration information is confidential under Section 2166, 2166.5, 2166.7, or 2166.8 may withhold the candidate's residence address from the declaration of candidacy. If a candidate does not state the candidate's residence address on the declaration of candidacy, the elections official shall verify whether the candidate's address is within the appropriate political subdivision and add the notation "verified" where appropriate on the declaration.

(c) If a candidate will not be within the State of California within the entire nomination period and is unable to appear before a notary public appointed by the Secretary of State or other state official to complete their declaration of candidacy, the candidate may appear before a notary public in another state to complete the declaration of candidacy. The candidate shall attach to their declaration of candidacy a notarial certificate from the out-of-state notary that complies with the law of the notary's state.