FOR OFFICE USE ONLY
Sec. State Rev. 08/05/2021
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), at the PRIMARY or GENERAL (circle one) Election to be held on the
______ 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 therefore I will meet the Constitutional and/or statutory age
(Month & Day)
(Year)
requirement for taking said office. I have resided in ________________________ county for ____ years, and
have resided in ________________________ precinct for _____ years.
_____________________________________________________________________________________
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 appear on the Notice of Official Write-In Candidates.
________________________________, ______________________________
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, 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. If running in the General Election, I
further certify that I am not disqualified from running as a write-in candidate pursuant to A.R.S. § 16-312(F).
___________________________________________ ________________________________
CANDIDATE SIGNATURE DATE
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