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HomeMy WebLinkAboutBallot Designation Worksheet - Trubee°" Riverside County, Registrar of Voters BALLOT DESIGNATION WORKSHEET (Elections Code §§ 131 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 designatio cO NOT & EAVE.ANY RESPONSE SPACES BLANK. If information requested is not applicable, please write "Ni in the space provided, otherwise the ii fonnatidn MUST be provided. UPON FILING, THIS WORKSHEET WILL BE A PUBLIC DOCUMENT, Candidate Information EyAr T be_€ Candidate Name r 1 Officer O't 44 li Email: pn cerl l r (aunt.' i t) •Pild111 1 oL° eGa.i Home Address: 1 ,..", 1� � e.$ e z CA '(2zG o Attorney or Attorney Name (or other person authorized to act on your behalf): C c, yv\ eJ' c) ✓ ' -_' , Other Authorized 2 Person Address: 2- Phone Number(s) U �• 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 ("1")]. (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 ilseek election to the same office. Proposed Ballot Designation(s): , `L&.\1 oc ' 1Jl7 S r e S ) © w,nef Proposed Ballot /'' I Designation(s) 3 Alternate Ballot Designation(s) 1: tj l) Ca I V ne ,,,,_ L.,/ I lta S r /1 tS S (C)W If your proposed ballot designation is pursuant to Elections Code § 13101(a)(3): The professions, vocations or occupations relied upon to support my proposed ballot designation(s) constitute my primary, main or leading professions, vocations or occupations. Initial E Translation of Proposed Designation: Gender specific translations will default to the masculine form for uniformity in translation unless you specify otherwise: (/J Masculine ( ) Feminine In the spaces provided on the next pane(s): (a) (b) (c) Describe why you believe you are entitled to use the proposed ballot designation. 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, 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). r^, CD (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. 0 sr+ W 'C) 91 Rev: 112025 ci Riverside County, Registrar of Voters S. BALLOT DESIGNATION WORKSHEET (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 1"PVO: Current or most recent job title: 0 t)' Start Date: b End Date: i1 L Employer Name or Business: W C o V / c Person who can verify this information: // Name: ?orn CL�, Phone Number( 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 4.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°r PVO: V C - t Current or most recent job title: Start Date:c End Date: N Employer Name or Business: 1c,U f Person who can verify this information: — Justification for use of 2nd PVO: v k� r M E=I Current or most recent job title: ✓7 c ) Jfla n Start Date: 'Z Z tZnd Date: Z Z Employer Name or Business: (b -s Persona who can verify this information: Rev: 112025