Form 4-G - Minor Political Party - Nominating Petition And Statement Of Candidacy
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1
2Form No. 4-G Prescribed by the Ohio Secretary of State (09-17)
Minor Political Party
Nominating Petition and Statement of Candidacy
General Election
To be filed with the Board of Elections not later than 110 days before the day of the general election and not
earlier than the date of filing of the minor party’s formation petition.
Note: If the office being sought by this petition is for that of a district or political subdivision located in more
than one county, this petition must be filed with the Board of Elections of the most populous county of the
district or political subdivision.
R.C. 3517.012, 3501.38, 3513.257, 3513.261, 3513.262
Statement of Candidacy
NOTE - The candidate must fill in, sign and date this statement of candidacy before the signatures of electors are
affixed.
I,
, the undersigned, hereby declare under penalty of election falsification that
Name of Candidate
my voting residence address is
,
, Ohio
,
Street Number and Address, if any,
City or Village
Zip Code
(or rural route and number)
and I am a qualified elector.
I further declare that I desire to be a candidate for election to the office of
for the:
Office
Check
full term commencing
unexpired term ending
or
, from the
one
Full Term Commencing Date
Unexpired Term Ending Date
District,
County, Ohio at the general election to be held on the
day of
District Number
County
Day
November,
.
Year
I further declare that I am an elector qualified to vote for the office I seek, and I desire to be the nominee for the
Party.
Name of Minor Political Party or
Prospective Minor Political Party
Dated this
day of
,
.
Day
Month
Year
Signature of Candidate
WHOEVER COMMITS ELECTION FALSIFICATION IS GUILTY OF A FELONY OF THE FIFTH DEGREE
I,
, hereby designate the persons named below as a committee to represent me:
Name of Candidate
Name
Residence
Nominating Petition
We, the undersigned, qualified electors of the State of Ohio, whose voting residence is in the county, city,
village, or township set opposite our names, hereby nominate
as a
Name of Candidate
candidate for election to the office of
for the:
Office
Check
full term commencing
or
unexpired term ending
, from
one
Full Term Commencing Date
Unexpired Term Ending Date
the
District,
County, Ohio to be voted for at the general election next
District Number
County
hereafter to be held, certify said person is, in our opinion, well qualified to perform the duties of the office or
position to which the person desires to be elected.
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