Form 3-D "Nominating Petition and Statement of Candidacy for United States Senator" - Ohio

What Is Form 3-D?

This is a legal form that was released by the Ohio Secretary of State - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2021;
  • The latest edition provided by the Ohio Secretary of State;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 3-D by clicking the link below or browse more documents and templates provided by the Ohio Secretary of State.

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Download Form 3-D "Nominating Petition and Statement of Candidacy for United States Senator" - Ohio

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Form No. 3-D Prescribed by the Ohio Secretary of State (06-21)
Nominating Petition and Statement of Candidacy
For United States Senator
To be filed with the office of the Secretary of State, not later than 4 p.m. of the day before the primary election.
R.C. 3513.257, .261, .262, .28; 3501.38
Statement of Candidacy
NOTE - The candidate must fill in, sign and date this statement of candidacy before the signatures of electors are
affixed.
I,
, the undersigned, hereby declare under penalty of election falsification that
Name of Candidate
my voting residence address is
,
,
.
Street Number and Address, if any,
State
Zip Code
City or Village
(or rural route and number)
I further declare that I desire to be a candidate for nomination to the office of United States Senator for the :
Check
, at the general election to be held on the
full term or
unexpired term ending
one
Unexpired Term Ending Date
day of November,
.
Day
Year
I further declare that, if elected to this office, I will qualify therefor.
Dated this
,
.
day of
Day
Month
Year
Signature of Candidate
WHOEVER COMMITS ELECTION FALSIFICATION IS GUILTY OF A FELONY OF THE FIFTH DEGREE
I,
, hereby designate the persons named below as a committee to represent me:
Name of Candidate
Name
Residence
Nominating Petition
We, the undersigned, qualified electors of the State of Ohio, whose voting residence is in the county, city,
village, or township set opposite our names, hereby nominate
as a
Name of Candidate
Check
candidate for election to the office of
for the:
full term or
one
Office
, to be voted for at the next general election, and certify said
unexpired term ending
Unexpired Term Ending Date
person is, in our opinion, well qualified to perform the duties of the office to which the person desires to be
elected.
Voting Residence
City, Village, or
Date of
Signature
County
Street Number and Address
Township
Signing
1.
2.
3.
4.
5.
6.
Form No. 3-D Prescribed by the Ohio Secretary of State (06-21)
Nominating Petition and Statement of Candidacy
For United States Senator
To be filed with the office of the Secretary of State, not later than 4 p.m. of the day before the primary election.
R.C. 3513.257, .261, .262, .28; 3501.38
Statement of Candidacy
NOTE - The candidate must fill in, sign and date this statement of candidacy before the signatures of electors are
affixed.
I,
, the undersigned, hereby declare under penalty of election falsification that
Name of Candidate
my voting residence address is
,
,
.
Street Number and Address, if any,
State
Zip Code
City or Village
(or rural route and number)
I further declare that I desire to be a candidate for nomination to the office of United States Senator for the :
Check
, at the general election to be held on the
full term or
unexpired term ending
one
Unexpired Term Ending Date
day of November,
.
Day
Year
I further declare that, if elected to this office, I will qualify therefor.
Dated this
,
.
day of
Day
Month
Year
Signature of Candidate
WHOEVER COMMITS ELECTION FALSIFICATION IS GUILTY OF A FELONY OF THE FIFTH DEGREE
I,
, hereby designate the persons named below as a committee to represent me:
Name of Candidate
Name
Residence
Nominating Petition
We, the undersigned, qualified electors of the State of Ohio, whose voting residence is in the county, city,
village, or township set opposite our names, hereby nominate
as a
Name of Candidate
Check
candidate for election to the office of
for the:
full term or
one
Office
, to be voted for at the next general election, and certify said
unexpired term ending
Unexpired Term Ending Date
person is, in our opinion, well qualified to perform the duties of the office to which the person desires to be
elected.
Voting Residence
City, Village, or
Date of
Signature
County
Street Number and Address
Township
Signing
1.
2.
3.
4.
5.
6.
Voting Residence
City, Village, or
Date of
Signature
County
Street Number and Address
Township
Signing
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
WHOEVER COMMITS ELECTION FALSIFICATION IS GUILTY OF A FELONY OF THE FIFTH DEGREE
Circulator Statement
Must be completed and signed by the circulator.
I,
, declare under penalty of election falsification that I reside at the address
Printed Name of Circulator
signatures;
appearing below my signature; that I am the circulator of the foregoing petition containing
Number
that I witnessed the affixing of every signature; that all signers were to the best of my knowledge and belief
qualified to sign; and that every signature is to the best of my knowledge and belief the signature of the person
whose signature it purports to be or of an attorney in fact acting pursuant to section 3501.382 of the Revised Code.
Signature of Circulator
Permanent Residence Address
City or Village
State
Zip Code
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