Sbe/ccf Form 5-501-502-801 - Certificate Of Withdrawal Or Declination

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Certificate of Withdrawal or Declination
Candidate Information
Name of Candidate
Election Year
□ Primary
□ General
□
□
Local
Federal
Office Sought
□
State
District
Residence Address
Mailing Address
County of Residence
(or Baltimore City)
Election District or Ward
Precinct
Party Affiliation
I hereby certify that I withdraw my candidacy, or decline my political party’s nomination for the office sought and
therefore will not appear on the ballot.
Signature of Candidate
Date
Subscribed and sworn to before me this
day of
,
Month
Year
SEAL:
Signature of Notary Public
Print Name of Notary Public
My Commission Expires
(Original must be filed with the appropriate election board.)
Maryland State Board of Elections
Division of Candidacy and Campaign Finance
P.O. Box 6486  151 West Street, Suite 200  Annapolis, MD 21401-0486
410-269-2880  800-222-8683  MD Relay 800-735-2258
SBE/CCF-Form #5-501-502-801 Revised 6/2007

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