Form 4-E - Minor Political Party - Nominating Petition And Statement Of Candidacy
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1
2Form No. 4-E Prescribed by the Ohio Secretary of State (09-17)
Minor Political Party
Nominating Petition and Statement of Candidacy
For State Office (Other than Governor/Lieutenant Governor and Supreme Court)
To be filed with the office of the Secretary of State not later than the 110 days before the day of the general election
and not earlier than the date of filing of the minor party’s formation petition.
R.C. 3517.012, 3513.257, 3513.261, 3501.38
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 nomination to the office of
Office
Check
for the:
, at the general election to be held on
full term or
unexpired term ending
one
Unexpired Term Ending Date
the
day of November,
.
Day
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
Check
candidate for election to the office of
for the:
full term or
one
Office
unexpired term ending
, to be voted for at the next general election, and certify said
Unexpired Term Ending Date
person is, in our opinion, well qualified to perform the duties of the office or position to which the person desires
to be elected.
Signatures on this petition must be from only one county and must be written in ink.
Voting Residence
City, Village, or
Date of
Signature
County
Street Number and Address
Township
Signing
1.
2.
3.
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