Form 2-Pa - Declaration Of Candidacy - Party Primary Election - For District Delegate Or District Alternate To The National Convention

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Form No. 2-PA Prescribed by Secretary of State (9-15)
DECLARATION OF CANDIDACY
PARTY PRIMARY ELECTION
For District Delegate or District Alternate to the National Convention
Only to be used by a candidate for president whose registered principal campaign committee treasurer
has certified that the candidate has met the contribution requirements contained in Division (A) of
Ohio Revised Code §3513.121.
th
To be filed with the Ohio Secretary of State not later than 4 p.m. of the 90
day before the day of the
primary election.
Revised Code 3513.05, .07, .09, .121
I, __________________________________________, the undersigned, hereby declare under penalty
(Name of Candidate)
of election falsification that my voting residence address is __________________________________,
(Street and Number, if any, or Rural Route Number)
_____________________________, Ohio ____________, and I am a qualified elector in my precinct.
(City or Village)
(Zip Code)
I am a member of, and I hereby declare that I desire to be a candidate of, the ____________________
Party for election as:
Delegate
Alternate from the ___________________________
(check one)
Congressional District of Ohio, to the ______________________________ National Convention at the
primary election to be held on the __________ day of _________________________,___________, as
provided by law.
I further declare that if elected, I will qualify therefor, and I will support and abide by the principles
enunciated by my party, in its national platform, and that I have not voted as a member of a different
political party at any primary election within the last two calendar years.
I hereby declare to the voters of my political party in the State of Ohio that, if elected to their party
convention, I shall, to the best of my judgment and ability, support that candidate for President of the
United States who shall have been selected at this primary by voters of my party in the manner
provided in Chapter 3513 of the Ohio Revised Code, as their candidate for such office.
Dated this ______ day of _______________________, __________.
______________________________________________
(Signature of Candidate)
WHOEVER COMMITS ELECTION FALSIFICATION IS GUILTY OF A FELONY OF THE FIFTH DEGREE
¹CHOICE FOR PRESIDENT OF THE UNITED STATES
By Candidate for District Delegate or District Alternate to the National Convention
Revised Code 3513.121
I, ______________________________________, a candidate for election as: (check one)
Delegate
(Name of Candidate)
Alternate from the _________________ Congressional District of Ohio to the _________________
National Convention, at the next primary election, do hereby state that ¹_________________________
________________________________________ is my first choice for nomination as candidate of my
party for the Presidency of the United States and that ¹_______________________________________
is my second choice therefor.
Dated this ______ day of _______________________, _____________.
_________________________________________
(Signature of Candidate)
¹The name of a candidate for President shall not be used without his/her written consent.

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