Looking for a Declaration Form Templates? Download it for free!

Form 2-F - Declaration Of Candidacy - Party Primary Election For District Office - 2013 Page 2

VOTING RESIDENCE ADDRESS

CITY, VILLAGE, OR

DATE OF

SIGNATURE

STREET AND NUMBER

COUNTY

TOWNSHIP

SIGNING

10.

11.

12.

13.

14.

15.

16.

17.

18.

– Must be completed and signed by circulator.

CIRCULATOR STATEMENT

I, ________________________________, declare under penalty of election falsification that I reside

(Printed Name of Circulator)

at the address appearing below my signature; that I am a member of the __________________ Party;

that I am the circulator of the foregoing petition containing ___________ signatures; that I witnessed

(Number)

the affixing of every signature; that all signers were to the best of my knowledge and belief qualified to

sign; and that every signature is to the best of my knowledge and belief the signature of the person

whose signature it purports to be or of an attorney in fact acting pursuant to section 3501.382 of the

Revised Code.

____________________________________

(Signature of Circulator)

WHOEVER COMMITS ELECTION

____________________________________

WHOEVER COMMITS ELECTION

FALSIFICATION IS GUILTY OF A

FALSIFICATION IS GUILTY OF

(Permanent residence address)

FELONY OF THE FIFTH DEGREE

____________________________________

A FELONY OF THE FIFTH DEGREE

(City or Village, State and Zip Code)

Form 2-F - Declaration Of Candidacy - Party Primary Election For District Office - 2013 Page 2