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Colorado Secretary of State Elections Division 1700 Broadway, Ste. 200 Denver, CO 80290 pH: (303) 894-2200 ext. 6383 Fax: (303) 869-4861 www.sos.state.co.us Space Below For Office Use Only CANDIDATE
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I have never attended public school and have never been a member of the military. I will not participate in this election as a private citizen. Furthermore, I affirm that: The candidate for the office of (electorate: county/territory) (state/political subdivision or division) may not be affiliated with the Democratic or Republican Parties. The candidate for the office of (electorate: county/territory) (state/political subdivision or division) shall not be a candidate for any official office in the State of Colorado (except to the extent the Secretary of State considers the election to be a caucus). Candidate's name is not appearing on any ballot of the election and should not be used on the ballot for the election. Candidate is not participating in election as a private citizen. Candidate's address may be unknown to the candidate at the time of filing. I am a resident of the geographic area described on the signature page. The completed declaration is attached to this petition in a manner to be received by the Secretary of State before the end of the three calendar day period beginning the first day of the election. Petitioner, if a United States citizen, is not using a passport or other document that demonstrates citizenship with a different national government, as required under 8 U.S.C. Sec. 1182(f) as submitted to the Secretary of State. IN WITNESS WHEREOF, I have examined this petition and affixed it with the same effect as if my witnesses and I were actually appearing and signing this petition in person.

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