The nomination paper for a candidate for the presidential preference portion of the ballot shall be in substantially the following form:

SECTION OF NOMINATION PAPER SIGNED BY VOTER ON BEHALF OF PRESIDENTIAL PREFERENCE PRIMARY CANDIDATE

Section ____________ Page ____________ County of ______________. Nomination paper of a presidential preference candidate for the American Independent Party presidential primary ballot. State of California County of ⎱ ⎰ ss. SIGNER’S STATEMENT I, the undersigned, am a voter of the County of ____________, State of California, and am registered as intending to affiliate with the American Independent Party.

I hereby nominate ____________ for the presidential preference portion of the American Independent Party’s presidential primary ballot, to be voted for at the presidential primary to be held on the ____________ day of ____________, 20____. I have not signed the nomination paper of any other candidate for the same office, or for any group of delegates, to the national convention of the party, and I further declare that I intend to support the candidate named herein. Number Signature Printed name Residence 1. 2. 3. etc. CIRCULATOR’S AFFIDAVIT I, ______, solemnly swear (or affirm) all of the following: 1.

That I am years of age or older. 2. That my residence address, including street and number, is . [If no street or number exists, a designation of my residence adequate to readily ascertain its location is .] 3. That I secured signatures in the County of ____ to the nomination paper of a candidate in the presidential preference primary of the American Independent Party; that all the signatures on this

section of the nomination paper numbered from to ____, inclusive, were made in my presence, that the signatures were obtained between ____, 20_, and ____, 20_, and that to the best of my knowledge and belief each signature is the genuine signature of the person whose name it purports to be. I declare under penalty of perjury that the foregoing is true and correct. (Signed) Circulator