Fillable Form 1: California Secretary of State BALLOT DESIGNATION (Mendocino College)

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Form 1: California Secretary of State BALLOT DESIGNATION (Mendocino College)

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California Secretary of State
BALLOT DESIGNATION WORKSHEET
(Elections Code §§ 13107, 13107.3, 13107.5; California Code of Regulations § 20711)
This entire form must be completed, or it will not be accepted and you will not be entitled to a ballot designation. DO NOT LEAVE ANY RESPONSE
SPACES BLANK. If information requested is not applicable, please write “N/A” in the space provided, otherwise the information MUST be provided. UPON
FILING, THIS WORKSHEET WILL BE A PUBLIC RECORD.
Candidate Name:
Gender (optional, for translation use only):
Office:
Email:
Candidate
Information
1
Home Address:
Mailing Address:
Business Address:
Phone Number(s)
Business:
Home/Mobile:
Fax:
Attorney Name (or other person authorized to act on your behalf):
Attorney
Information
2
Address:
Mobile:
Fax:
You may select as your ballot designation one of the following designations:
(a)
Your current principal profession(s), vocation(s), or occupation(s) [maximum total of three words, separated by a slash (“/”)].
(b)
The full title of the public office you currently occupy and to which you were elected.
(c)
“Appointed [full title of public office]” if you currently serve by appointment in an elective public office and are seeking election to the same office or
t
o some other office
.
(d)
“Incumbent” if you were elected (or, if you are a Superior Court Judge, you are a candidate for the same office that you hold) to your current
publ
ic office and seek election to the same offic
e.
(e)
“Appointed Incumbent” if you were appointed to your current elective public office and seek election to the same office.
Proposed Ballot Designation(s):
Proposed
Ballot
Designation(s)
3
Alternate Ballot Designation(s) 1:
Alternate Ballot Designation(s) 2:
In the spaces provided on the next page(s):
(a)
Describe why you believe you are entitled to use the proposed ballot designation.
(b)
If your proposed ballot designation contains one or more slashes (“/”) separating words in your ballot designation for separate principal
profession(s), vocation(s), or occupation(s) (collectively known as “PVOs”), complete a justification section for each separate PVO.
(c)
Attach any documents or exhibits that you believe support your proposed ballot designation.
(d)
If using the title of an elective office, attach a copy of your certificate of election or appointment.
(e)
Any supporting documents will not be returned to you. Do not submit originals.
I
t is your responsibility to justify your proposed ballot designation and to provide all requested details.
If your proposed ballot designation includes the word “volunteer,” indicate the title of your volunteer position and the name of the entity for which you
volunteer along with a brief description of the type of volunteer work you do and the approximate amount of time involved. You may only use the ballot
designation “community volunteer” if you volunteer for a 501(c)(3) charitable, educational, or religious organization, a governmental agency or an
educational institution. You may not use “community volunteer” together with another designation.
Rev 09/2019
California Secretary of State
BALLOT DESIGNATION WORKSHEET
Page 2
If your proposed ballot designation contains one or more slashes (“/”) separating multiple principal profession(s), vocation(s), or occupation(s)
(collectively known as “PVOs”), complete a justification section for each separate PVO.
Justification
for use of
Proposed
Ballot
Designation(s)
If you are
proposing
alternate ballot
designations,
please provide
justification for
use of those on
Page 3.
Justification for use of 1
st
PVO:
Current or most recent job title: Start/End Dates:
Employer Name or Business:
Person who can verify this information:
Name: Phone Number(s): Email:
Justification for use of 2
nd
PVO:
Current or most recent job title: Start/End Dates:
Employer Name or Business:
Person who can verify this information:
Name: Phone Number(s): Email:
Justification for use of 3
rd
PVO:
Current or most recent job title: Start/End Dates:
Employer Name or Business:
Person who can verify this information:
Name: Phone Nu er(s): Em il:mb a
4
Before signing below, answer/initial the following questions. Does your proposed ballot designation:
1) Use only a portion of the title of your current elected office? Yes No Initial
2) Non-judicial candidates: Use only the word “Incumbent” for an elective office to which you were appointed? Yes No Initial
3) Use more than three total words for your principal professions, vocations, or occupations? Yes No Initial
4) Suggest an evaluation of you, such as outstanding, leading, expert, virtuous, or eminent? Yes No Initial
5) Refer to a status (Veteran, Activist, Founder, Scholar), rather than a profession, vocation, or occupations? Yes No Initial
6) Abbreviate the word “retired? Yes No Initial
7) Place the word “retired” after the words it modifies? Example: Accountant, retired Yes No Initial
8) Use an word or prefix (except “retired”) such as “former” or “ex-” to refer to a former profession, vocation, or occupation? Yes No Initial
9) Use the word “retired” along with a current profession, vocation, or occupation? Example: Retired Firefighter/Teacher Yes No Initial
10) Use the name of a political party or political body? Yes No Initial
11) Refer to a racial, religious, or ethnic group? Yes No Initial
12) Refer to any activity prohibited by law? Yes No Initial
If the answer to any of these questions is “yes,” your proposed ballot designation is likely to be rejected.
X / /
Candidate’s Signature Date Signed: Month Day Year
For your reference, attached are Elections Code sections 13107, 13107.3, and 13107.5, and California Code of Regulations (CCR), title 2, section 20711. You also may wish
to consult CCR, title 2, sections, 20712-20719 (found at www.sos.ca.gov).
Rev 09/2019
California Secretary of State
BALLOT DESIGNATION WORKSHEET
Page 3
COMPLETE THIS PAGE ONLY IF one or more Alternate Ballot Designation(s) are provided. If this page is not applicable, please initial: .
A
Justification for use of 1
st
PVO:
Current or most recent job title:
Start/End Dates:
Employer Name or Business:
Person who can verify this information:
Name:
Phone Number(s):
Email:
Justification for use of 2
nd
PVO:
Current or most recent job title:
Start/End Dates:
Employer Name or Business:
Person who can verify this information:
Name:
Phone Number(s):
Email:
Justification for use of 3
rd
PVO:
Current or most recent job title:
Start/End Dates:
Employer Name or Business:
Person who can verify this information:
Name:
Phone Number(s):
Email:
Justification for
Alternate Ballot
Designation(s) 1
B
Justification for use of 1
st
PVO:
Current or most recent job title:
Start/End Dates:
Employer Name or Business:
Person who can verify this information:
Name:
Phone Number(s):
Email:
Justification for use of 2
nd
PVO:
Current or most recent job title:
Start/End Dates:
Employer Name or Business:
Person who can verify this information:
Name:
Phone Number(s):
Email:
Justification for use of 3
rd
PVO:
Current or most recent job title:
Start/End Dates:
Employer Name or Business:
Person who can verify this information:
Name:
Phone Number(s):
Email:
Justification for
Alternate Ballot
Designation(s) 2
Rev 09/2019
California Secretary of State
BALLOT DESIGNATION WORKSHEET
Page 4
For your reference, the relevant provisions of Elections Code section 13107 are reproduced below:
(a) With the exception of candidates for Justice of the State Supreme Court or court of appeal, immediately under the name of each candidate, and not separated
from the name by any line, unless the designation made by the candidate pursuant to Section 8002.5 must be listed immediately below the name of the candidate
pursuant to Section 13105, and in that case immediately under the designation, may appear at the option of the candidate only one of the following designations:
(1) Words designating the elective city, county, district, state, or federal office which the candidate holds at the time of filing the nomination documents to which he
or she was elected by vote of the people.
(2) The word “incumbent” if the candidate is a candidate for the same office which he or she holds at the time of filing the nomination papers, and was elected to
that office by a vote of the people.
(3) No more than three words designating either the current principal professions, vocations, or occupations of the candidate, or the principal professions, vocations,
or occupations of the candidate during the calendar year immediately preceding the filing of nomination documents.
(4) The phrase “appointed incumbent” if the candidate holds an office by virtue of appointment, and the candidate is a candidate for election to the same office, or, if
the candidate is a candidate for election to the same office or to some other office, the word “appointed” and the title of the office. In either instance, the candidate
may not use the unmodified word “incumbent” or any words designating the office unmodified by the word “appointed.” However, the phrase “appointed incumbent”
shall not be required of a candidate who seeks reelection to an office which he or she holds and to which he or she was appointed, as a nominated candidate, in
lieu of an election, pursuant to Sections 5326 and 5328 of the Education Code or Section 7228, 7423, 7673, 10229, or 10515 of this code.
(b) (1) Except as specified in paragraph (2), for candidates for judicial office, immediately under the name of each candidate, and not separated from the name by
any line, only one of the following designations may appear at the option of the candidate:
(A) Words designating the city, county, district, state, or federal office held by the candidate at the time of filing the nomination documents.
(B) The word “incumbent” if the candidate is a candidate for the same office that he or she holds at the time of filing the nomination papers.
(C) No more than three words designating either the current principal professions, vocations, or occupations of the candidate, or the principal professions,
vocations, or occupations of the candidate during the calendar year immediately preceding the filing of nomination documents.
(2) For a candidate for judicial office who is an active member of the State Bar employed by a city, county, district, state, or by the United States, the designation
shall appear as one of the following:
(A) Words designating the actual job title, as defined by statute, charter, or other governing instrument.
(B) One of the following ballot designations: “Attorney,” “Attorney at Law,” “Lawyer,” or “Counselor at Law.” The designations “Attorney” and “Lawyer” may be used
in combination with one other current principal profession, vocation, or occupation of the candidate, or the principal profession, vocation, or occupation of the
candidate during the calendar year immediately preceding the filing of nomination documents.
(3) A designation made pursuant to subparagraph (A) of paragraph (1) or paragraph (2) shall also contain relevant qualifiers, as follows:
(A) If the candidate is an official or employee of a city, the name of the city shall appear preceded by the words “City of.”
(B) If the candidate is an official or employee of a county, the name of the county shall appear preceded by the words “County of.”
(C) If the candidate is an official or employee of a city and county, the name of the city and county shall appear preceded by the words “City and County.”
(D) If the candidate performs quasi-judicial functions for a governmental agency, the full name of the agency shall be included.
(c) A candidate for superior court judge who is an active member of the State Bar and practices law as one of his or her principal professions shall use one of the
following ballot designations as his or her ballot designation: “Attorney,” “Attorney at Law,” “Lawyer,” or “Counselor at Law.” The designations “Attorney” and
“Lawyer” may be used in combination with one other current principal profession, vocation, or occupation of the candidate, or the principal profession, vocation, or
occupation of the candidate during the calendar year immediately preceding the filing of nomination documents.
(d) For purposes of this section, all California geographical names shall be considered to be one word. Hyphenated words that appear in any generally available
standard reference dictionary, published in the United States at any time within the 10 calendar years immediately preceding the election for which the words are
counted, shall be considered as one word. Each part of all other hyphenated words shall be counted as a separate word.
(e) The Secretary of State and any other elections official shall not accept a designation of which any of the following would be true:
(1) It would mislead the voter.
Rev 09/2019
California Secretary of State
BALLOT DESIGNATION WORKSHEET
Page 5
(2) It would suggest an evaluation of a candidate, such as outstanding, leading, expert, virtuous, or eminent.
(3) It abbreviates the word “retired” or places it following any word or words which it modifies.
(4) It uses a word or prefix, such as “former” or “ex-,” which means a prior status. The only exception is the use of the word “retired.”
(5) It uses the name of any political party, whether or not it has qualified for the ballot.
(6) It uses a word or words referring to a racial, religious, or ethnic group.
(7) It refers to any activity prohibited by law.
(f) If, upon checking the nomination documents and the ballot designation worksheet described in Section 13107.3, the elections official finds the designation to be
in violation of any of the restrictions set forth in this section, the elections official shall notify the candidate by registered or certified mail return receipt requested,
addressed to the mailing address provided on the candidate’s ballot designation worksheet.
(1) The candidate shall, within three days, excluding Saturday, Sunday, and state holidays, from the date he or she receives notice by registered or certified mail, or
from the date the candidate receives actual notice of the violation, whichever occurs first, appear before the elections official or, in the case of the Secretary of
State, notify the Secretary of State by telephone, and provide a designation that complies with subdivision (a) or (b).
(2) If a candidate fails to provide a designation that complies with subdivision (a) or (b) within the three-day period specified in paragraph (1), a designation shall not
appear after the candidate’s name.
(g) A designation given by a candidate shall not be changed by the candidate after the final date for filing nomination documents, except as specifically requested by
the elections official as specified in subdivision (f) or as provided in subdivision (h). The elections official shall maintain a copy of the ballot designation worksheet for
each candidate that appears on the ballot in the county for the same period of time as applied to nomination documents pursuant to Section 17100.
(h) The designation shall remain the same for all purposes of both primary and general elections, unless the candidate, at least 98 days before the general election,
requests in writing a different designation which the candidate is entitled to use at the time of the request.
For your reference, Elections Code section 13107.3 is reproduced below:
(a) A candidate who submits a ballot designation pursuant to subdivision (a) of Section 13107 shall file a ballot designation worksheet that supports the use of that
ballot designation by the candidate, in a format prescribed by the Secretary of State.
(b) The ballot designation worksheet shall be filed with the elections official at the same time that the candidate files his or her declaration of candidacy.
(c) In the event that a candidate fails to file a ballot designation worksheet in accordance with subdivision (a), no designation shall appear under the candidate’s
name on the ballot.
For your reference, Elections Code section 13107.5 is reproduced below:
(a) A candidate’s ballot designation as “community volunteer” shall constitute a valid principal vocation or occupation for purposes of subdivision (a) of Section
13107, if not otherwise in violation of any of the restrictions set forth in that section, and subject to the following conditions:
(1) A candidate’s community volunteer activities constitute his or her principal profession, vocation, or occupation.
(2) A candidate is not engaged concurrently in another principal profession, vocation, or occupation.
(3) A candidate may not use the designation of “community volunteer” in combination with any other principal profession, vocation, or occupation designation.
(b) The Secretary of State shall by regulation define what constitutes a community volunteer for purposes of this section.
For your reference, California Code of Regulations section 20711 is reproduced below:
(a) In order to facilitate review of a candidate's proposed ballot designation by the Secretary of State pursuant to Elections Code § 13107, the candidate shall
submit, at the time of filing his or her proposed ballot designation on the Declaration of Candidacy, a completed Ballot Designation Worksheet on a form provided by
the Secretary of State.
(b) All Ballot Designation Worksheets filed with the Office of the Secretary of State or the county elections officials pursuant to this section shall be public records
and shall be available for inspection and copying at the public counter of the Elections Division of the Office of the Secretary of State, Fifth Floor, 1500 11th Street,
Sacramento, California 95814, or at the office of the applicable county elections official.
Rev 09/2019
California Secretary of State
BALLOT DESIGNATION WORKSHEET
Page 6
(c) The Secretary of State shall provide a master copy or copies of the Ballot Designation Worksheet to all elections officials responsible for providing and accepting
the nomination documents for candidates in elections for offices certified by the Secretary of State. The Ballot Designation Worksheet shall request that the
candidate proposing the ballot designation provide the following information:
(1) The candidate's name, home, business and mailing addresses, telephone numbers, e-mail address, if available, and fax number;
(2) A designation of the office for which the candidate is seeking election;
(3) The name, home, business and mailing addresses, telephone numbers, e-mail address, if available, and fax number of the attorney representing the candidate
or for any other person to be contacted in the event the Secretary of State requires further information regarding the proposed ballot designation;
(4) The proposed ballot designation submitted by the candidate;
(5) The candidate may submit one or more proposed alternate ballot designations ranked in order of the candidate's preference;
(6) A brief statement identifying the factual basis upon which the candidate claims the proposed ballot designation and each proposed alternate ballot designation,
including the following:
(A) If the candidate holds elected office and is submitting his or her proposed ballot designation pursuant to Elections Code § 13107, subdivisions (a)(1) or (a)(2),
the candidate shall indicate the elective office he or she currently occupies and may attach a copy of his or her Certificate of Election;
(B) If the candidate is a judicial officer and is submitting his or her proposed ballot designation pursuant to Elections Code § 13107, subdivisions (a)(1) or (a)(2), the
candidate shall indicate the elective office he or she currently holds and may attach either (A) a copy of his or her Certificate of Election or (B) a copy of his or her
commission or certificate of appointment, issued at the time the candidate was appointed to the judicial office which he or she currently occupies;
(C) If the candidate submits a ballot designation pursuant to Elections Code § 13107, subdivision (a)(3), the candidate shall indicate:
(i) The title of the position or positions which he or she claims supports the proposed ballot designation;
(ii) The dates during which the candidate held such position;
(iii) A description of the work he or she performs in the position;
(iv) The name of the candidate's business or employer;
(v) The name and telephone number of a person or persons who could verify such information; and
(vi) A statement that the professions, vocations or occupations relied upon to support the proposed ballot designation constitute the primary, main or leading
professions, vocations or occupations of the candidate, in accordance with the definition of the term “principal” as set forth at § 20714, subdivision (b).
(D) If the candidate submits a ballot designation pursuant to Elections Code § 13107, subdivision (a)(4), the candidate shall indicate the date on which he or she
was appointed to the office for which he or she is an appointed incumbent.
(d) The candidate may attach or append any supporting documents or other exhibits to his or her Ballot Designation Worksheet which he or she believes support his
or her proposed ballot designation. Such attached documents or other exhibits shall be deemed to be incorporated by reference as part of the candidate's Ballot
Designation Worksheet and shall be considered as such by the Secretary of State.
(e) If a candidate requests a change of his or her ballot designation pursuant to Elections Code § 13107(e), that request shall be accompanied by a Ballot
Designation Worksheet.
Rev 09/2019
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Form 1: California Secretary of State BALLOT DESIGNATION (Mendocino College)

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Completed 4 September 2020

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