HomeMy WebLinkAbout2013 Ballot Designation Worksheet - ChristiansonBALLOT DESIGNATION WORKSHEET
This worksheet is intended to assist in the prompt evaluation of requested ballot des ignations
Required to be given to candidate
Required to be signed and returned
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Name of tarl
Candidate forthe Office of A ( vnlt.e r
(lncluding district or
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Home Address
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Daytime Telephone N
E-mail
Name of Attorney or Other Person Authorized to Act in
Your Behalf:
His/Her Fax Nu
(area code)
Telephone
(area code)
E-mail Address:_
PROPOSED BALLOT DESIGNATION:r3 ann n
(Note: Designation must be your principal profession,vocation or occupation and may be no more three words;
however, you may use the full title of the office you currently hold.)
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Describe what you do and why you title of an elective office,you may submit a copy of your cerlificate
The term "incumbent" must be used as a noun. tt shalt not be used in conjunction with any other words, including any accompanyingadjectives or modifiers, and must stand alone.le"A
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lf above not accepted,1"t alternative:
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Your Job
Dates You Held the
Name of Your Employer or Busin
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VU"hf Contact Person(s) Who Can Verify this tnformation
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0 Me/lca"t /'g Telephone Num I 5 f6o-lo
(area code)
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to use
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To the best of my knowledge and belief, the above-requested ballot designation(s) represent my true principal profession(s), vocation(s)and/or occupation(s) which I am entitled to use as my ballot designations pursuant to S 13107.5 of the Elections Code.
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You may attach whatever supporling documentation or exhibits you wish that you believe support your proposed ballot designationThese documents will not be returned to you, so do not submit original versions.
Sign
O\Forms\Nomination Documents\Ballot Designation Worksheet
2013 / Revised 10/2012 *'.n'
CANDIDA'I c,iS STATEMENT INFORMA'| r
Complete this form, and submit with your candidate statement. Please use all regular lower case letters (do not use all ).Provide a brief description of no more than 200 words, of the candidate's education and qualifications.
Be sure to include the official title of the olfice you are a candidate for, your name, age, and occupation.
(see bottom of reverse side for sample format)
. Required to be given to candidate'luired to be completed and returned\,N SHEET
9 Enter the candidates' name and the office titte:.
's name)tr Male pfemale
( wtht n ,l Yl"t C r Co
9 Enter the name of the jurisdiction to which the oflice belongs,
if other than the name of the city (i.e, the name of the school dishict).
(4 Jurisdiction name)
Car\ya ChnisttAnson
Cl'
(,lt Office Title)
(i.e., Mayor, Member of the City Council, City Clerk,
Member of the Board of Education, etc.)
I DO WANT my Candidate Statement to appear in the following languages in the Sample Bal
\ _ tl Spanish / Colloquial (informal) ! Chinese / Traditional I Japanese n
-(English f,spanish / Castillian (formal) U Chinese / Simplified n Vietnamese n
lot Voter Pamphlet:
Korean n Tagalog
tr I DO NOT WANT to file a candidate statement.
Signature of candidate
STATE LAW PROVIDES (per Election Code Section 18307):
1. A Candidate Statement is optional and available to all candidates for nonpartisan offices.
2. The statement may include candidate's age, occupation and a brief description of education and qualifications
(expressed by the candidate himself or herself).
3. Each local jurisdiction determines:
a. the maximum number of words allowed, usually 200 words
b. responsibility for payment, the candidate or the jurisdiction
c. whether the costs are to be paid in advance.
4. Reference to political party affiliation or mention of any paftisan political membership or activity is not permitted.
5. Reference to other candidates for that office or to another candidate' s qualifications, character, or activities are prohibited.
(EC 13308).
6. No changes of any kind are allowed AFTER the statement is filed.
7' The statement may be withdrawn (in writing) up to 5:00 pm of the next working day after the close of the nomination period.
8. Statements are confidential until after the close of the nomination period.
9' A candidate may request that the statement also be printed in other languages and included in the Sample Ballot Voter
lnformation Pamphlet mailed to all voters in the election area. An additional fee may be required to print the additional
languages.
CANDIDATE STATEMENTS MUST BE FILED AT THE TIME NOMINATION PAPERS ARE FILED.
The estimated cost is determined prior to all information being available, therefore, it is an approximation of the actual cost that
may be significantly more or less depending on the actual number of candidates filing statements.
For Election officiat's use onty: Estimated Cost of Printing Candidate's Statement in
English: $ .......... / spanish: $.......... I
-:
9........., I
-:
g.......... i
-:
$.
lf applicable, the below estimated cost is for the Translations (and formatting if translation is provided by the candidate)
and this cost does not include printing, which cost is noted above:
spanish: : $.......... I
-:
$.......... I
-:
9.......... I
-:
9........
Election Official: a. Send one copy of this page and the candidate statement to the vendor/printer
b. keep original set for youriiles
c. make one copy for the candidate
d. make one or more copies for the translato(s) if necessary.
Candidate Statement lnformation Sheet
2013 / Revised 10/2012
(more information on reverse side) )
MC Elections