The nomination paper for a candidate for the presidential preference primary ballot shall be in substantially the following form:

SECTION OF NOMINATION PAPER SIGNED BY VOTER ON BEHALF OF PRESIDENTIAL PREFERENCE PRIMARY CANDIDATE

Section ____________Page ____________

County of __________.

Nomination paper of a presidential preference candidate for the Green Party presidential preference primary ballot.

State of California

County of

⎱ ⎰

ss.

SIGNER’S STATEMENT

I, the undersigned, am a voter of the County of ____________, State of California, and am registered as preferring the Green Party. I hereby nominate ____________ for the presidential preference portion of the Green Party’s presidential primary ballot, to be voted for at the presidential preference primary to be held on the____________ day of ____________, 20____. I have not signed the nomination paper of any other candidate for the same office.

Number_________Signature_________Printed name_________Residence

1.

2.

3.

etc.

CIRCULATOR’S DECLARATION

I, ________, affirm all of the following:

1.That I am 18 years of age or older.

2.That my residence address, including street number, is. [If no street or number exists, a designation of my residence adequate to readily ascertain its location is.]

3.That I secured signatures in the County of ________ to the nomination paper of a candidate in the presidential preference primary of the Green Party, that all the signatures on this section of the nomination paper numbered from 1 to ______, inclusive, were made in my presence, that the signatures were obtained between ____________, 20__, and ____________, 20__, and that to the best of my knowledge and belief each signature is the genuine signature of the person whose name it purports to be.

I declare under penalty of perjury that the foregoing is true and correct.

Executed at ________, California, this ____ day of ____, 20__.

[Signed] ______________________________

Circulator

[Printed Name] _____________________________

(Amended by Stats. 2016, Ch. 86, Sec. 103. (SB 1171) Effective January 1, 2017.)