America’s Third Party:Petition to participate in theprimary election.

NOTICE TO THE PUBLICTHIS PETITION MAY BE CIRCULATED BY A PAID SIGNATURE GATHERER OR AVOLUNTEER. YOU HAVE THE RIGHT TO ASK. Page _____ of ______

We, the undersigned, registered, qualified voters of California, residents of ______Countydeclare that we represent America’s Third Party. We desire to have America’s Third Party participate in the primary election. Our residence addressesare correctly set forth after our signatures hereto:

NO VOTER MAY SIGN MORE THAN ONE NOMINATION PAPER FOR THE SAME OFFICE. ANY PERSON REGISTERED TO VOTE AT THE ELECTION, AND QUALIFIED TO VOTE FOR THE ELECTIVE OFFICE OF THE CITY FOR WHICH THE NOMINATION IS MADE, MAY
CIRCULATE A NOMINATION PAPER. ONLY ONE PERSON MAY CIRCULATE EACH NOMINATION PAPER. (E.C. 10220) / This column for official use only.
1. / Print Your
Name:______
Sign As
Registered
To Vote:______/ Residence
Address ONLY:______
City:______Zip:______
2. / Print Your
Name:______
Sign As
Registered
To Vote:______/ Residence
Address ONLY:______
City:______Zip:______
3. / Print Your
Name:______
Sign As
Registered
To Vote:______/ Residence
Address ONLY:______
City:______Zip:______
4. / Print Your
Name:______
Sign As
Registered
To Vote:______/ Residence
Address ONLY:______
City:______Zip:______
5. / Print Your
Name:______
Sign As
Registered
To Vote:______/ Residence
Address ONLY:______
City:______Zip:______
6. / Print Your
Name:______
Sign As
Registered
To Vote:______/ Residence
Address ONLY:______
City:______Zip:______
7. / Print Your
Name:______
Sign As
Registered
To Vote:______/ Residence
Address ONLY:______
City:______Zip:______
8. / Print Your
Name:______
Sign As
Registered
To Vote:______/ Residence
Address ONLY:______
City:______Zip:______

AFFIDAVIT OF CIRCULATOR

(to be completed after above signatures have been obtained)

I, ______, circulator of this petition, certify under penalty of perjury under the

(Circulator’s printed name)

laws of the State of California that the following statements are true and correct:

· That I circulated this petition;

· That I witnessed the appended sponsors’ signatures being written in my presence, and that to the best of my information and

belief each signature is the genuine signature of the person whose name it purports to be;

· That all signatures were affixed to this document between the dates of ______, ______,

and ______, ______.

· That my residence address is ______

Executed this______day of ______, ______at______, California.

By ______

(Circulator’s Signature)

[Dates of circulation, printed name, and residence address must be in circulator’s own hand.]

Examined and certified by me this ______day of ______,______.

By ______

(Signature of Election Official)

WARNING: Every person acting on behalf of a candidate is guilty of a misdemeanor who deliberately fails to file at the

proper time and in the proper place any nomination paper or declaration of candidacy in his or her possession that is

entitled to be filed under the provisions of the Elections Code. (Elections Code Section 18202)