"Affidavit of Intent for Write-In Designation - United States Representative" - Colorado

Affidavit of Intent for Write-In Designation - United States Representative is a legal document that was released by the Colorado Secretary of State - a government authority operating within Colorado.

Form Details:

  • Released on May 12, 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 "Affidavit of Intent for Write-In Designation - United States Representative" - Colorado

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Affidavit of Intent for Write-In Designation
Office Use Only:
United States Representative
Complete, sign, and return this form to the Colorado Secretary of State. Please type or print legibly.
Office Information
United States Representative, District #
Write-in Candidate for the:
Primary Election
OR
General Election
Qualifications for Office (You must check each box to affirm that you meet the qualifications for this office)
At least 25 years old
Inhabitant of Colorado
U.S. citizen for at least 7 years
Candidate Information
Full Legal Name
Name
exactly as it will appear on the write-in list
Residence & Mailing Address
Residence Street Address
State
Zip Code
City
Mailing Street Address
State
City
Zip Code
Telephone & E-mail Address
Business Phone #
Extension
Residence Phone #
E-mail Address
Campaign Website (optional)
Website
Voter Registration Information
Year of Birth
County of Registration
Party Affiliation
Date of Affiliation
Signature
Applicant's Affirmation
I hereby intend to run for the office stated above and solemnly affirm that I meet all qualifications for the office prescribed by law. Furthermore, the
information provided on this form is, to the best of my knowledge, true and correct.
[seal]
______________________________________________
__________________
Signature of Candidate
Date of Signing
STATE OF COLORADO
COUNTY OF
___________________
Subscribed and sworn to before me this ________ day of _______________________, 20_____ by ____________________________________________________ .
Day
Month
Year
Printed name of Candidate Above
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
ax: (303) 869-4861
SOS Revised May 12, 2015
Print Form
Section 1-4-1101, C.R.S.
Email: ballot.access@sos.state.co.us
Affidavit of Intent for Write-In Designation
Office Use Only:
United States Representative
Complete, sign, and return this form to the Colorado Secretary of State. Please type or print legibly.
Office Information
United States Representative, District #
Write-in Candidate for the:
Primary Election
OR
General Election
Qualifications for Office (You must check each box to affirm that you meet the qualifications for this office)
At least 25 years old
Inhabitant of Colorado
U.S. citizen for at least 7 years
Candidate Information
Full Legal Name
Name
exactly as it will appear on the write-in list
Residence & Mailing Address
Residence Street Address
State
Zip Code
City
Mailing Street Address
State
City
Zip Code
Telephone & E-mail Address
Business Phone #
Extension
Residence Phone #
E-mail Address
Campaign Website (optional)
Website
Voter Registration Information
Year of Birth
County of Registration
Party Affiliation
Date of Affiliation
Signature
Applicant's Affirmation
I hereby intend to run for the office stated above and solemnly affirm that I meet all qualifications for the office prescribed by law. Furthermore, the
information provided on this form is, to the best of my knowledge, true and correct.
[seal]
______________________________________________
__________________
Signature of Candidate
Date of Signing
STATE OF COLORADO
COUNTY OF
___________________
Subscribed and sworn to before me this ________ day of _______________________, 20_____ by ____________________________________________________ .
Day
Month
Year
Printed name of Candidate Above
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
ax: (303) 869-4861
SOS Revised May 12, 2015
Print Form
Section 1-4-1101, C.R.S.
Email: ballot.access@sos.state.co.us