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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.

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.

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

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