HomeMy WebLinkAboutBallot Designation Worksheet - QuintanillaRiverside County, Registrar of Voters
BALLOT DESIGNATION WORKSHEET
•.. ,.•° November 5 2024 General Election (Elections Code §§ 13107, 13107.3r 13107.5: California Code of Regulations § 20711)
This entire form must be completed, or it will not be accepted and you will not be entitled to a bal'ot designation_ DO NOT LEAVE ANY RESPONSE
SPACES BLANK. If information requested is not applicable, please write "NIA" in the space provided, otherwise the information MUST be provided. UPON
FILING, THIS WORKSHEET WILL BE A PUBLIC DOCUMENT.
Candidate Name I ! V Gender tional, for translation use only): r
Office Email:
t Home Address: 43101 -Z-M 0- CMU" CA gaa(po
Information
Mailing Address: )AME A-'_;� ArI&OVE
4
Bus_ness Address:
Phone Number(s)
41 Business7, Home Mobile: 7 zi `
- 3XP
Attome� Name (or other arson authorized to act onyouur_ behaHl.
Attorney — -- -- 6 Fn M i
Information 2 Address: '
Phone Numbensi
Bus ness Molrie: _ Fax: =0 i
You may select as your ballot designation one of the following designations:
.P- :).;
� rn
(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.
Proposed Proposed Ballot Designation(s): D fyC IL Val b MA n/
Ballot 3
Designation(s) Alternate Ballot Designation(s) t:
Alternate Ballot Designatlon(s) 2:
In the spaces provided on the next pa e s :
(a) Describe why you believe you are entitled to use the proposed ballot designation.
(b) If your proposed ballot designation contains one or more slashes ("P) separating words in your ballot designation for separate principal profession(s),
vocation(s), or occupation(s) (collectively known as "PVOs"), complete a justification section for each separate PVO.
(c) Attach any documents or exhibits that you believe support your proposed ballot designation.
(d) If using the title of an elective office, attach a copy of your certificate of election or appointment.
(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 05/2024
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 (T) separating multiple principal profession(s), vocation(s), or occupation(s) (collectively
known as "PVW), complete a justification section for each separate PVO.
Justification
for use of
Proposed
Ballot
Designation(s)
If you are
proposing
alternate ballot
des'gnations,
please provide
justification for
use of those on
Page 3.
kEd
Justification for use of 1" PVO:
Current or most recent job title: COY NC I LV C) k1A ANI
Start/End Dates
Qo 00 — v) r.aq
Employer Name or Business: CITA OF F}LM MERE
Person who can verify this information:
Name: 5E hp—Af-14EO PhoneNumbe•fs;:
Email.
Justification for use of 2^d PVo,
r�
c x r� .
`�
Current or most recent job fide: � v lOT14 C7 R
Start/End Dates
1 Oil
Employer Name or Business: M,4RIA DE JESUL
CM LOSS
t,
Person who can verify this information:
w
Name Phone Number(s)-
Email:
x—
Justification for use of 31d PVO:
Current or most recent 'ob title:
StarllEnd Dates:
Employer Name or Business:
Person who can verify this information:
Name: Phone Number(s)
Email:
Before signing below, answerlinitial the following questions. Does your proposed ballot designation:
1)
Use only a portion of the title of your current elected office?
Wes QAo
Initial
2)
Non -judicial candidates: Use only the word "Incumbent' for an elective office to which you were appointed?
❑Yes 2(No
3)
Use more than three total words for your principal professions, vocations, or occupations?
❑Yes ZNo
Initial
4)
Suggest an evaluation of you, such as outstanding, leading, expert, virtuous, or eminent?
❑YeSAW
Initial
5)
Refer to a status (Veteran, Activist, Founder, Scholar), rather than a profession, vocation, or occupations?
❑YesZNo
Initial
6)
Abbreviate the word 'retired?
❑YesZNo
Initial
7)
Place the word "retired' after the words it modifies? Example: Accountant, retired
❑YesZNo
Initial
8)
Use a word or prefix (except 'retired') such as 'former' or 'ex-! to refer to a former profession, vocation, or occupation?
❑Yeseft
Initial
9)
Use the word "retired' along with a current profession, vocation, or occupation? Example: Retired FirefighterfTeacher
❑Yes.no
Initial
10)
Use the name of a political party or political body?
❑Yes B'No
Initial
11)
Refer to a racial, religious, or ethnic group?
❑YesAo
InItIal
12)
Refer to any activity prohibited by law?
0Yes4ErNo
Initial
If the answer to any of these questions is "yes," your proposed ballot designation is likely to be rejected,
X
G y
0 q l Pb
Candidate's Signature Date Signed: Month
Day
Year
For your reference, attached are Elections Code sections 13107, 13107.3, and 13 $07.5, and California Code of Regulations (CCR), title 2 section 20711 _ You also may wish
to consult CCR, title 2, sections, 20712-20719 (found at www.sos.ca.gov).
Rev 0512024
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 Drovided. If this pffle is not applicable. olease initial:
Justification for '
Alternate Ballot i A
Designation(s) I j
Justification for
Alternate Baltot
Designation(s) 2
B
Justification for use of Its' PVO
Current or most recent job tTe
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 Utle:
StarUEnd Dates:
Em to er Name or Business
C
Person who can verify this information:
t
iY.
Name:
Phone Number(s):
Email:
Justification for use of 3'd PVO:
Current or most recent job title:
StartfEnd Dates:
00
Employer Name or Bus ness:
Person who can verify this Information:
Name:
Phone Number(s):
Email
Justification for use of lit PVO:
Current or most recent job title-
StarUEnd Dates -
Employer Name or Business:
Person who can verify this information:
Name:
Phone Number(s)-
Email:
Justification for use of 2^d PVO-
Current or most recent'ob bile:
StarUEnd Dates
Employer Name or Business:
Person who can verify this information:
Name:
Phone Number(s):
Email:
Justification for use of 3'd PVO:
Current or most recent job title:
StarUEnd Dates:
Em Io er Name or Business:
Person who can verify this information:
Name:
Phone Number(s):
Email:
Rev 0SUD24
United States of America
Certiicate of Election
. rM,
State of California,
County o amide ISS.`
qutcze.Jq"ha city Clerk,
of the City of Yalm De6va State of California,
certify, that at a qvwtal Atun&ipaj Election,
held in the City on gu.,eo dag, Nauwz6m 3, 2020,
was elected to the office of
A&m&A af ffw &y, OuuwA
as appears by the official returns of the election and the statement of
votes cast now on fife in my office.
I affix my hand and official sea[ this ?
I&A day Of Decwtb", 2V20 N i9'��, -
City clerk
oA2x OR AFFIRMATION
OF,qLLEGIANC-E FOR
P7.IBLIC OFFICERS ADD
State of Cafifamia,
County o
City of
`mac T-Vcutbn of this Oath is Required 6.y Artic(e XX, Section 3, of the
Constitution of the ,State of Caf forma.
do solemnly affirm that I rviff support and defend the Constitution of
the United ,States and the Constitution of the .State of California
agaima all enemies, fore u and domestic, that I z ifl bear tree faith
and affeg ance to the Cora.str!tution of the United States and the
Constitution of the State of Calforn a; that I tare tks obl ation
free(, without any tuenta(reservation or purpose of evasion; andthat I
tviff zveff andfaitFafu((y disc rar e the duties upon which I am about to
cnter.
,Subscribed andsworn to before me tfiis
!0 ,fay of
/L
41teureoRftcer."tlrtttr� dk y
eaf� aua
Tide4 0A,, isurfas Oath •—
"c'tu _r rson'fa it oatl