"Certificate of Designation by Assembly" - Colorado

Certificate of Designation by Assembly is a legal document that was released by the Colorado Secretary of State - a government authority operating within Colorado.

Form Details:

  • Released on May 7, 2015;
  • The latest edition currently provided by the Colorado Secretary of State;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Colorado Secretary of State.

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Download "Certificate of Designation by Assembly" - Colorado

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Office Use Only:
Certificate of Designation By Assembly
Complete, sign, and return this form to the Colorado Secretary of State no later than 4 days after
adjournment of the assembly.
Office & District
Office
District
Assembly Information
Name of Political Party
County
Location of Assembly
Date
Number of Assembly Delegates Present and Voting
Names of all Candidates Receiving Votes by Assembly (Must include the rank order of Votes Received and Percentage)
---------------Ballot 1------------------- ----------------Ballot 2--------------------
Votes
% of Vote
Votes
% of Vote
Name & Address of Candidate
Rank
Rank
Received
Received
Received
Received
Assembly Requirements (Please check all boxes that are applicable)
No more than 2 ballots were taken for the office listed on this form.
First Ballot
At least one candidate received 30 percent or more of the votes of all delegates who were present and voted for this office.
No candidate received 30 percent, therefore a second ballot was cast for ALL candidates.
Second Ballot
At least one candidate received 30 percent or more of the votes of all delegates who were present and voted for this office.
No candidate received 30 percent or more of the votes cast, therefore the TWO candidates that received the highest number of
votes are designated by the assembly.
Affiliation Requirement
I certify that each of the candidates listed on this form have been affiliated with the political party for the time period required by
party rule or by law if the party has no such rule.
Colorado Secretary of State
1700 Broadway, Suite 200
Denver, Colorado 80290
Phone: (303) 894-2200
F
SOS Revised May 7, 2015
ax: (303) 869-4861
Print Form
Sections 1-4-601 & 1-4-1304 C.R.S.
Email: ballot.access@sos.state.co.us
Page 1
Office Use Only:
Certificate of Designation By Assembly
Complete, sign, and return this form to the Colorado Secretary of State no later than 4 days after
adjournment of the assembly.
Office & District
Office
District
Assembly Information
Name of Political Party
County
Location of Assembly
Date
Number of Assembly Delegates Present and Voting
Names of all Candidates Receiving Votes by Assembly (Must include the rank order of Votes Received and Percentage)
---------------Ballot 1------------------- ----------------Ballot 2--------------------
Votes
% of Vote
Votes
% of Vote
Name & Address of Candidate
Rank
Rank
Received
Received
Received
Received
Assembly Requirements (Please check all boxes that are applicable)
No more than 2 ballots were taken for the office listed on this form.
First Ballot
At least one candidate received 30 percent or more of the votes of all delegates who were present and voted for this office.
No candidate received 30 percent, therefore a second ballot was cast for ALL candidates.
Second Ballot
At least one candidate received 30 percent or more of the votes of all delegates who were present and voted for this office.
No candidate received 30 percent or more of the votes cast, therefore the TWO candidates that received the highest number of
votes are designated by the assembly.
Affiliation Requirement
I certify that each of the candidates listed on this form have been affiliated with the political party for the time period required by
party rule or by law if the party has no such rule.
Colorado Secretary of State
1700 Broadway, Suite 200
Denver, Colorado 80290
Phone: (303) 894-2200
F
SOS Revised May 7, 2015
ax: (303) 869-4861
Print Form
Sections 1-4-601 & 1-4-1304 C.R.S.
Email: ballot.access@sos.state.co.us
Page 1
Name of Secretary or Chairman:
Name
Phone #
Address
Members of the Assembly Vacancy Committee:
Under section 1-4-601(2), C.R.S., assemblies are required to select a vacancy committee to fill vacancies in designation or nomination.
The assembly did not select vacancy committee members. Any vacancy in designation for the office on this form will be filled per party bylaws.
The assembly chose the following people as vacancy committee members to fill vacancies in designation for the office on this form.
Name
Phone #
Address
Name
Phone #
Address
Name
Phone #
Address
Name
Phone #
Address
Name
Phone #
Address
Name
Phone #
Address
Name
Phone #
Address
Additional members can be attached.
Signature
Affirmation of Secretary or Chairman
I solemnly affirm that the party I represent is qualified to nominate candidates by assembly. Furthermore, the information provided on this form is, to the
best of my knowledge, true and correct.
______________________________________________
__________________
Signature of Secretary or Chairman
Date of Signing
[seal]
STATE OF COLORADO
COUNTY OF
___________________
Subscribed and sworn to before me this ________ day of _______________________, 20_____ by ____________________________________________________ .
Day
Month
Year
Printed name of Secretary or Chairman
Signature (and Title) of Notary / Official Administering Oath ____________________________________________________________________________________
My Commission Expires: ___________________
Colorado Secretary of State
1700 Broadway, Suite 200
Denver, Colorado 80290
Phone: (303) 894-2200
F
SOS Revised May 7, 2015
ax: (303) 869-4861
Print Form
Sections 1-4-601 & 1-4-1304 C.R.S.
Email: ballot.access@sos.state.co.us
Page 2
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