CITY OF SANTA MONICA

 

BALLOT DESIGNATION WORKSHEET

 

(This worksheet is intended to assist in the prompt evaluation of requested ballot designations.)

 

 

NAME OF CANDIDATE: _______________________________________________

 

OFFICE SOUGHT: _______________________________________________

(Including district or division number, if applicable)

 

HOME ADDRESS: _______________________________________________

(Number and Street Address)

 

_______________________________________________

(City, State and Zip Code)

 

BUSINESS ADDRESS: _______________________________________________

(Number and Street Address)

 

_______________________________________________

(City, State and Zip Code)

 

MAILING ADDRESS: _______________________________________________

(If different from above)

 

DAYTIME TELEPHONE NUMBER: ________________ EVENING: ___________________

 

FAX TELEPHONE NUMBER: ________________ E-MAIL: ___________________

 

 

NAME OF PERSON AUTHORIZED TO ACT IN YOUR BEHALF:

 

______________________________________

 

HIS/HER FAX NUMBER: _________________ TELEPHONE NUMBER: ________________

 

AND E-MAIL ADDRESS: ____________________

 

PROPOSED BALLOT DESIGNATION: _________________________________

(Note: Designation must be your principal profession, vocation or occupation and may be no more than three words; however,

you may use the full title of the elective office you currently hold. See Elections Code Section 13107.)

 

 

 

If not accepted, 1st alternative: ____________________________________

 

2nd alternative: ____________________________________


Describe what you do and why you believe you are entitled to use the requested ballot designation.

 

 

 

 

 

 

 

YOUR JOB TITLE: ____________________________________________________________

 

DATES YOU HELD THE POSITION: _____________________________________________

 

NAME OF YOUR EMPLOYER OR BUSINESS: _____________________________________

 

CONTACT PERSON(S) WHO CAN VERIFY THIS INFORMATION:

 

NAMES(S): ______________________________________________

 

TELEPHONE NUMBER(S): _________________________________

(area code)

 

To the best of my knowledge and belief, the above-requested ballot designation(s) represent my true principal profession(s), vocation(s) and/or occupation(s) which I am entitled to use as my ballot designations pursuant to 13107 of the Elections Code.

 

Signed and dated this _____ day of ______________, 20____, in ____________________________.

location

 

___________________________________

Signature

 

You may attach whatever supporting documentation or exhibits you wish that you believe support your proposed ballot designation. These documents will not be returned to you, so do not submit original versions.