HomeMy WebLinkAboutDeclaration of Candidacy - PollyRiverside County, Registrar of Voters
DECLARATION OF CANDIDACY
Nonpartisan Office — For Use in Local Elections
November 3, 2026, General Municipal Election (Elections Code §§ 20, 200.8002.5, 8020, 8020.5, 8040.8121,13405)
For Elections
Officials USE
ONLY
Official Filing Form
Elections pFflci I
By: _ �4%t lu{
Date Issued: b� (o
Filed in:
By: 4 v*t4
Date Received:
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Elections Official
I hereby declare myself a candidate for the nomination/election to the office of
�a I De -564r- � C1 O her
to be voted for at the General Municipal Election to be held on November 3, 2026, and declare the following to be true / 5"r' cf y
Candidate Name r
and Office My name is o v o 1(
First Middle/Initial (optional) Las
IMPORTANT NOTE: A ballot designation is optional. If one is requested, a completed BALLOT DESIGNATION WORKSHEET must be submitted If
no ballot designation is requested, write "NONE" and initial in the box (Elections Code §§ 13107 13107.3)
I request my name and ballot designation to appear on the ballot as follows:
Ballot
Information
J o n ci. -1'h 0 r Po /
Candidate
Name and ballot
2 Print Your Name for Use on he Ballot J I I
box if
NO of initials
designation to
Q
I (%Gtif Ur
designation
appear on the
ballot
Print Ballot esignation Requested
is preferred.
[If applicable in your City•County) I have a character based name I would like to use instead of a phonetic transliteration. (You must complete Character -
Based Name Form)
IMPORTANT NOTE: The Registrar of Voters will publish your name and proposed ballot designation. You may also have a mailing address, residential
address, email
and/or phone number published on the election official's website.
ONLY CHECK
ONE BOX. Please check the appropriate box to indicate which ddress you wish to be used f r publishing purpo e .
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Publish ❑ --> Mailing Address: ' Apt. or Unit #
City/State/Zip Code: LZ(
Publish❑ Residence Address (Required): Apt. or Unit #
Pa 1 C`I q Zi II
City/State/Zip Code: r" p,+ -f
Addresses,
Telephone,
Publish❑ e, Business Address: 0 I 0 Apt. or Unit #
Internet
Website and
3
City/State/Zip Code:
Email
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Publish -4 Email: -
IMPORTANT: Reverse Side of Page Must Be Completed
Rev: 112025
I meet the statutory and constitutional qualifications for this office (including, but not limited to, citizenship and residency). I am at present an
incumbent of the following public office (if any):
I have not been convicted of a felony involving accepting or giving, or offering to give, any bribe, the embezzlement of public money, extortion
Qualifications 4 or theft of public money, perjury, or conspiracy to commit any of those crimes.
the nominationielection and not withdraw, except as permitted by state law
Signature of Candidate
ll
I, JB Y'o► °n j, I , do solemnly swear (or affirm) that I will support and defend the Constitution of the
United States and the Constitution of the State of California against all enemies, foreign and domestic; that I will bear true faith and allegiance
to the Constitution of the
well and faithfully discharge the duties upon which I am about to enter.
Signature of Candidate
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which
this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of Calif nia
County of de,f_ati,) e _
Subscribed and sworn to (or affirmed) before me on this " day of 5 E , 20 2C' , by
, proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me.
Notary Public
or
Other Officer
;Y
Signature of Notary Public
(Notary Public Seal) (or other officer) • „ �i
Examined and certified by me this da L_.. , 20 Z(o .
Elections Official
WARNING: Every person acting on behalf of a candidate is guilty of a misdemeanor who deliberately fails to file at t e oper time and in the proper place any declaration
of candidacy in the person's possession that is entitled to be filed under the provisions of the Elections Code. (Elections Code § 18202.)
Rev: 112025