HomeMy WebLinkAboutBallot Designation Worksheet - ScottRiverside County, Registrar of Voters
BALLOT DESIGNATION WORKSHEET
•..,.,.,° November 5, 2024 General Election (Elections Code §§ 13107, 13107.3. 13107.5, Callfomi Wa o(. utJons C20711)
ip A t Hl v g E:r+ F r A
This entire form must be completed, or it will not be accepted and you will not be entitled to a ballot �n�jip� f %N(�1�L�IV �1NY RESPONSE
SPACES BLANK. If information requested is not applicable, please write "NIA" in the space provided, othe e e n atior�i j S e provided. UPON
FILING, THIS WORKSHEET WILL BE A PUBLIC DOCUMENT.
Candidate 1
Information
Candidate Name: s---n r ,m D /-r Gender (optional, for translation use only):
�
Home Address: _
Address:
Phone Number(s) //` �, „ //�
Business: 7Gb Mobile: 7G/ /(/
Attorney Name or other person authorized to act on your behal : / Y
Attorney
Information Address:
Phone Number(s)/�� /j
Business: /�' Mobile: / Y Fax: / r' /7
You may select as your ballot designation one of the following designations:
(a) Your current principal profession(s), vocation(s), or occupation(s) [maximum total of three words, separated by a slash
(b) The full title of the public office you currently occupy and to which you were elected.
(c) "Appointed [full title of public office]" if you currently serve by appointment in an elective public office and are seeking election to the same office or
to some other office.
(d) "Incumbent" if you were elected (or, if you are a Superior Court Judge, you are a candidate for the same office that you hold) to your current
public office and seek election to the same office. NOTE: A candidate for the office of Representative in Congress, Member of the State Board
of Equalization, State Senator, or Member of the Assembly shall not choose the word "incumbent" as a designation to appear on the
ballot.
(e) "Appointed Incumbent" if you were appointed to your current elective public office and seek election to the same office.
&514,c5-5 0 )1eV-
Proposed Ballot Designation(s): /ill
Proposed
Ballot Alternate Ballot De*nation(s} 1
Designation(s)
Alternate Ballot Des' nations 2:
In the spaces provided on the next a e s :
r
w
On-x
(a)
Describe why you believe you are enfitied to use the proposed ballot designation.
b
(}
If our proposed ballot designation contains one or more slashes /" separating words in our ballot designation for separate r�i al � 1ession s
Y P P 9 (" } P g Y 9 P P P PrA ().
vocation(s), or occupation(s) (collectively known as "PVOs"), complete a justification section for each separate PVO.
Uo
(c)
Attach any documents or exhibits that you believe support your proposed ballot designation.
ry
(d)
If using the title of an elective office, attach a copy of your certificate of election or appointment.
`'ri
(e)
Any supporting documents will not be returned to you. Do not submit originals.
It is your responsibility to justify your proposed ballot designation and to provide all requested details.
If your proposed ballot designation includes the word "volunteer," indicate the title of your volunteer position and the name of the entity for which you volunteer
along with a brief description of the type of volunteer work you do and the approximate amount of time involved. You may only use the ballot designation
"community volunteer" if you volunteer for a 501(c)(3) charitable, educational, or religious organization, a governmental agency or an educational institution.
You may not use "community volunteer" together with another designation.
Rev 0=024
Riverside County, Registrar of Voters
BALLOT DESIGNATION WORKSHEET
:.:. November 5, 2024 General Election (Elections Code §§ 13107. 13107 3, 13107 5, California Code of Regulations § 20711)
Page 2
If your proposed ballot designation contains one or more slashes ("r) separating multiple principal profession(s), vocation(s), or occupabon(s) (collectively
known as "PVOs'): complete a justification section for each separate PVO.
Justification
for use of
Proposed
Ballot
Designation(s)
If you are
proposing
alternate ballot
designations,
please provide
justification for
use of those on
Justification for use of 1,' PVO-
Current or most recent lob title: 0114�7
StartiEnd Dates 2D22
Employer Name or Business:
Person who can verify this information:
Name: &r s[� Phone Number(s): %
Justification for use of 2nd PVO:
Current or most recent mob title:
Start/End Dates
Employer Name or Business.
Person who can verify this Information:
Na—e: Phone Number(s).
Email:
Justification for use of 3nd PVO:
Current or most recent job title:
StartiEnd Dates.
Employer Name or Business
Person who can verify this information:
Name Phone Number(s):
Email:
Before signing below, answer/initial the following questions. Does your proposed ballot designation:
1)
Use only a portion of the title of your current elected office?
Dyes ta'No
Initia
2)
Non -judicial candidates: Use only the word 'Incumbent" for an elective office to wh;ch you were appointed?
Dyes Oo
Initia
3)
Use rnore than three total words for your principal professions, vocations, or occupations?
Dyes no
Initia
4)
Suggest an evaluation of you, such as outstanding leading. expert, virtuous, or eminent?
❑YesTANo
Initi
5)
Refer to a status (Veteran Activist Founder, Scholar;, rather than a profession, vocation, or occupations?
Dyes f'1No
Initia
6)
Abbreviate the word 'retired?
Dyes ta'No
Initi
7)
Place the word 'retired' after the words d modifies? Example: Accountant, retired
Dyes 1D1lo
Initia
8)
Use a word or prefix ?excepl'retired') such as 'forme' or'ex-' to refer to a former profess on, vocation, or occupation?
❑Yes tia'No
Initia
9)
Use the word 'ret red' along with a current profession, vocation or occupation? Example: Retired F,refighterfTeacher
[]Yes VNo
Initia
10)
Use the name of a political party or political body?
❑Yes UNo
Initial
11)
Refer to a racial re igious or ethnic group?
❑Yes o
Initia
12)
Refer to any activity prop bated by law?
Dye sVVfNo
Initi
If the answer to any of these questions is "yes," your proposed ballot designation is likely to be rejected.
X
For your reference, attached are Elections Code sections 13107, 13107 3, and '3107 5, and California Code of Regulations (CCR). title 2, section 20711. You also may wish
to consult CCR, title 2, sections, 20712-20719 (found at vnwsos.ca.covl.
Rev 05l2024
. -6r 3Tr
r. Riverside County, Registrar of Voters
.� BALLOT DESIGNATION WORKSHEET
.: November 5. 2024 General Election (Elections Code §§ 13107. 13107.3. 13107 5; California Code of Regulations § 20711)
Page 3
COMPLETE THIS PAGE ONLY IF one or more Alternate Ballot Designation(s) are provided If this page is not applicable, please initial:
Justification for f
Alternate Ballot A
Designation(s)1 I
r
Justification for
Alternate Ballot B
Designation(s) 2
Justification for use of to PVO:
Current or most recent'ob title:
Start/End Dates:
Employer Name or Business:
Person who can verify this Information:
Name;
Phone Numberi,s;.
Email;
Justification for use of 294 PVO:
Current or most recent' b titic:
Start/End Dates
Employer Name or Busi--ess:
Person who can verify this information:
Name
Phone Number(s):
Email
Justification for use of 3rd PVO:
Current or most recent lob title:
SlarUEnd Dates
Employer Name or Business:
Person who can verify this information:
Name:
Phone Number(s).
Email:
Justification for use of 1't PVO:
Current or most recent job title:
Start/End Dates:
Employer Name or Business:
Person who can verify this information:
Name:
Phone Number(s):
Email:
Justification for use of 2nd PVO'
Current or most recent job title:
StarVEnd Dates:
Employer Name or Business:
Person who can verify this Information:
Name:
Phone Number(s):
Email:
Justification for use of 31d PVO:
Current or most recent job title:
Start/End Dates:
Employer Name or Business:
Person who can verify this information:
Name:
Phone Number(s):
Email:
Rev 0512024
2rEAK x�
PROPERTY MANAGEMENT
Chris Scott
E.O /Owner
DRE#
office:
Cell:
Email:
Web - www.valleypeakpm.com