The nomination paper for a candidate for the presidential preference primary 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 Green Party presidential preference 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 preferring the Green Party. I hereby nominate ____________ for the presidential preference portion of the Green Party’s presidential primary ballot, to be voted for at the presidential preference primary to be held on the____________ day of ____________, 20____.

I have not signed the nomination paper of any other candidate for the same office. Number_________Signature_________Printed name_________Residence 1. 2. 3. etc. CIRCULATOR’S DECLARATION I, ________, affirm all of the following: 1. That I am years of age or older. 2. That my residence address, including street 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 Green 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. Executed at ________, California, this ____ day of ____, 20__. [Signed] ______________________________ Circulator [Printed Name] _____________________________