STATE OF ARIZONA
DECLARATION OF QUALIFICATION
A.R.S. § 16-311
Sec. State Rev. 04/04/2017
You are hereby notified that I, the undersigned, a qualified elector, am a candidate for the office of
______________________________ at the election to be held on __________________________.
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 and will meet the age requirement for the office I seek
and 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 appear on the ballot, 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
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