FOR OFFICE USE ONLY
STATE OF ARIZONA
Write-in Candidate
NOMINATION PAPER
DECLARATION OF QUALIFICATION
A.R.S. §§ 16-311, 16-312
You are hereby notified that I, the undersigned, a qualified elector, am a candidate for the office of
______________________________________________for the __________________________ Party (if
applicable) to be voted on at the PRIMARY or GENERAL (circle one) election to be held on ____ day of
_____________________, 20____.
I will have been a citizen of the United States for
years before my election and will have been
a citizen of Arizona for years before my election. I am ______ years old and my date of birth is
___________________, __________, and I have resided in _______________ County for years
and in precinct for years before my election.
Actual residence address City or town Zip
or description of place of residence (required)
Post office address (if applicable) City or town Zip
Print or type your name on the following line in the exact manner you
wish it to be listed on the Notice of Official Write-In Candidates, last name first.
,
LAST NAME FIRST NAME
I declare, under penalty of perjury, that the information in this Nomination Paper and Declaration of
Qualification is true and correct, and that at the time of filing I am a resident of the county, district or precinct
which I propose to represent, that I have no final, outstanding judgments against me of an aggregate of $1,000
or more that arose from failure to comply with or enforcement of campaign finance law, and as to all other
qualifications, I will be qualified at the time of election to hold the office that I seek.
________________________________________ ____________________________________
CANDIDATE SIGNATURE DATE
League Revision 06/30/17
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