HomeMy WebLinkAboutBallot Designation Worksheet - PerrycN
Riverside County, Registrar of Voters
•'BALLOT DESIGNATION WORKSHEET
(Elections Code §§ 13107, 131073, 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 ballot designation. DO NOT LEAVE ANY RESPONSE
SPACES BLANK. If information requested is not applicable please write "N/A" in the space provided, otherwise the information MUST be provided. UPON
FILING, THIS WORKSHEET WILL BE A PUBLIC DOCUMENT.
Candidate
Information
Office: PA L ^'n D1 J •
A
Home Address: ( ,
Mailing Address:
Business Address:
Phone Number(s)
Business; ( Mobile:
Fax:
Attorney or Attorney Name or other person authorized to act on your behal : `v ~••
Other
Authorized 2 Address
Person
Information Phone Number(s)
Business. Mobile Fax:
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.
(e) "Appointed Incumbent" if you were appointed to your current elective public office and seek election to the same office.
�
Proposed Ballot Designation(s). C e' . n r OLu' i ee r•
Proposed Ballot ,J
Designation(s) 3 Alternate Ballot Designation(s) 1; _
Alternate Ballot Designation(s) 2:
If your proposed ballot designation is pursuant to Elections Code § 13107(a)(3):
The professions, vocations or occupations relied upon
of Proposed Designation: Gender specific translations will default to the masculine form for uniformity in translation unless you specify
otherwise: (.) Masculine ( ) Feminine
In the spaces provided on the next page(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. (Note: It is not necessary to provide copies of
Certificates of Election if you are currently a seated member for a voter•nominated office).
(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.
Rev: 112025
Riverside County, Registrar of Voters
BALLOT DESIGNATION WORKSHEET
•y..'(Elections Code §§ 13107, 13107.3, 13107.5; California Code of Regulations § 20711)
Page 2
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.
If your proposed ballot designation contains one or more slashes ("I") separating multiple principal profession(s), vocation(s), or occupation(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
Page 3.
Justification for use of 15' PVO:
n2 ,vt. v ► -F
L e
Current or most recent job title: i
Start Dat -
Z End Date:&,7 Q
Employer Name or Business:
ih Q
2O 2f
Person who can verify this informati n:
Name:fl,,, ,, ' , e LJ me [ i
Phone Number(s):' _
Email:
Justification for Je of 2"d PVO'
G o ut,%
VL1,frqI
Current or most recent Job title: '
L
lr Start Date: — I- 2_Lf End Date:
Employer Name or Business:
Person who can verify this information:
Name'
Phone Number(s):
Email:
Justification for use of 3m PVO:
-.a
Current or most recent job title:
Start Date
End DU
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?
❑ Yes
I No
Initial
2)
Non -judicial candidates: Use only the word "Incumbent" for an elective office to which you were appointed?
❑ Yes
No
If the answer to any of these questions is "yes," your proposed ballot designation is likely to be
rejected.
Date Signed: Month!DayIYear
For your reference, attached are Elections Code sections 13107, 13107.3, and 13107.5, 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: 112025
Riverside County, Registrar of Voters
BALLOT DESIGNATION WORKSHEET
••' (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
Alternate Ballot
Designation(s) 1
Justification for
Alternate Ballot
Designation(s) 2
Justification for use of 1 PVO
Current or most recent job title:
Start Date:
End Date:
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:
Start Date:
End.Dete:
Employer Name or Business:
Person who can verify this information:
Name:
Phone Number(s):
Email
_
Justification for use of 3rd PVO:
Current or most recent job title:
Start Date:
End D'at: _
Employer Name or Business:
Person who can verify this information:
Name:
Phone Number(s):
Email:
Justification for use of 1 PVO:
Current or most recent job title:
Start Date: End Date:
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:
Start Date: End Date:
Employer Name or Business:
Person who can verify this information:
Name:
Phone Number(s)
Email
Justification for use of 3rd PVO:
Current or most recent job title:
Start Date: End Date:
Employer Name or Business
Person who can verify this information:
Name
Phone Number(s).
Email.
Rev: 112025