DECLARATION OF WRITE-IN CANDIDACY FOR THE
November 8, 2016 General Election Declaration of Write-in Candidacy
Office: State Senator District #: ___________
Legal name of candidate – please print:
___________________________________ ________________________________ _________________________
(Last name and suffix, if any) (First name) (Middle name or initial)
Voting Residence Address of Candidate: __________________________________________________________________
(Street Name and Number - not P.O. Box) (City, Town, or Plantation; Zip Code)
Mailing Address of Candidate: ________________________________________________________________
(Complete if different from above address)
Party or Political Designation: _________________________________________________________________
(See “Write-In Candidate Requirements” for further instructions.)
Qualifications of State Senator (Maine Constitution, Article IV, Part Second, Section 6)
At the time of nomination for placement on the general election ballot, the person shall:
▪ Be a resident in the district which the person seeks to represent.
At the commencement of the period for which that person is elected, the person shall:
▪ Have been a citizen of the United States for at least 5 years;
▪ Be at least 25 years of age;
▪ Have been a resident of this State at least one year; and
▪ Have been a resident in the district which the person seeks to represent for the 3-month period immediately preceding the election.
Candidate’s Consent
I hereby declare my consent to accept the nomination of the general election. I further declare that I reside in the municipality listed above; that I meet the qualifications to hold this office as listed above; and that this declaration is true.
______________________________________________________
(Signature of Candidate)
Subscribed to and sworn before me on this date: _______________ ________________________________
(Date) (Signature of Notary Public)
________________________________
(Printed Name of Notary Public)
Certification of Voter Registration -- Completed by Registrar in Candidate’s Municipality of Residence
I hereby certify that _______________________________________________________ is registered to vote
(Name of Candidate)
in this municipality as of this date.
___________________________________________________
(Signature of Registrar/Municipal Clerk)
_____________________ ___________________________________________________
(Date) (Name of Town, City or Plantation)
Filing deadline for Declaration of Write-in Candidacy is 5 pm on Friday, September 9, 2016
(60 days before the General Election)
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