Form CFFM052 "Petition for Indigent Candidate to Secure Ballot Status" - Delaware

Form CFFM052 is a Delaware Department of Elections form also known as the "Petition For Indigent Candidate To Secure Ballot Status". The latest edition of the form was released in November 9, 2015 and is available for digital filing.

Download a PDF version of the Form CFFM052 down below or find it on Delaware Department of Elections Forms website.

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Download Form CFFM052 "Petition for Indigent Candidate to Secure Ballot Status" - Delaware

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PETITION
FOR INDIGENT CANDIDATE TO SECURE BALLOT STATUS
CANDIDATE NAME AND OFFICE SOUGHT:
PARTY:
By dating and affixing my printed name and signature to this petition, I hereby swear and affirm that 1) my full name,
address at which registered, and Social Security Number (if supplied) are as stated herein; 2) I am a duly registered
elector residing in the County stated below; 3) I desire that the Candidate listed above shall have his or her name listed
on the ballot for the Election; 4) the date entered opposite my signature is the date on which I signed this petition; and
5) I have read and understand this paragraph, and I understand that by intentionally entering false information hereon,
I shall be subject to prosecution for perjury.
NOTE: Disclosure of your Social Security Number on this petition is voluntary. Your signature will not be disqualified
for failure to supply your number. Until the petition is turned over to the State of Delaware, the State has no control
over any uses made of it. Once in the control of the State, your Social Security Number derived from this petition will
be used only for administrative purposes relating to voting, including identifying you as a registered voter, preventing
duplication of names on petitions and verifying your address and other information.
Signature and Printed Name
Print your Complete Address
Social Security or
County of
Date
(Sign and Print your Full Name
#
and Zip Code
Voter ID # (Optional)
Residence
Signed
as you are Registered)
1
2
3
4
5
6
7
8
9
10
I witnessed the placing of each signature on this petition and, to the best of my knowledge and belief, all persons who
signed this petition were duly registered voters of the County involved. In addition, I understand that by intentionally
entering false information hereon I shall be subject to prosecution for perjury.
SIGNATURE OF WITNESS
ADDRESS OF WITNESS
Sworn before me this _____________________ day of _____, 20 _____.
NOTARY PUBLIC
COUNTY
Campaign Finance Section
Petition to Secure Ballot
CFFM052 V1.1 2015/11/09
PETITION
FOR INDIGENT CANDIDATE TO SECURE BALLOT STATUS
CANDIDATE NAME AND OFFICE SOUGHT:
PARTY:
By dating and affixing my printed name and signature to this petition, I hereby swear and affirm that 1) my full name,
address at which registered, and Social Security Number (if supplied) are as stated herein; 2) I am a duly registered
elector residing in the County stated below; 3) I desire that the Candidate listed above shall have his or her name listed
on the ballot for the Election; 4) the date entered opposite my signature is the date on which I signed this petition; and
5) I have read and understand this paragraph, and I understand that by intentionally entering false information hereon,
I shall be subject to prosecution for perjury.
NOTE: Disclosure of your Social Security Number on this petition is voluntary. Your signature will not be disqualified
for failure to supply your number. Until the petition is turned over to the State of Delaware, the State has no control
over any uses made of it. Once in the control of the State, your Social Security Number derived from this petition will
be used only for administrative purposes relating to voting, including identifying you as a registered voter, preventing
duplication of names on petitions and verifying your address and other information.
Signature and Printed Name
Print your Complete Address
Social Security or
County of
Date
(Sign and Print your Full Name
#
and Zip Code
Voter ID # (Optional)
Residence
Signed
as you are Registered)
1
2
3
4
5
6
7
8
9
10
I witnessed the placing of each signature on this petition and, to the best of my knowledge and belief, all persons who
signed this petition were duly registered voters of the County involved. In addition, I understand that by intentionally
entering false information hereon I shall be subject to prosecution for perjury.
SIGNATURE OF WITNESS
ADDRESS OF WITNESS
Sworn before me this _____________________ day of _____, 20 _____.
NOTARY PUBLIC
COUNTY
Campaign Finance Section
Petition to Secure Ballot
CFFM052 V1.1 2015/11/09
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