PRIMARY ELECTION PETITION NOMINATING CANDIDATE(S) FOR ESSEX COUNTY TO: CHRISTOPHER J. DURKIN, CLERK OF THE COUNTY OF ESSEX The undersigned, hereby certify that we are residents of the County of Essex, State of New Jersey, and that we are qualified voters therein, that we are members of the below indicated Party, and that we intend to affiliate with the said party at the ensuing General election; that we endorse the person(s) hereinafter mentioned as candidate(s) for the nomination for the office(s) set forth below and that we request you print upon the Primary Ballot of the said party the name(s) of said person(s) as the candidate(s) for such nomination(s). We further certify that the residence(s) and post office address(es) of said person(s) so endorsed is as herein set forth: OFFICE: (Enter name of office) PARTY: (Enter either Republican or Democrat) Name Residence Address City Zip Code 1. 2. 3. 4. COMMITTEE ON VACANCIES (The Committee on Vacancies may only fill a vacancy up to 55 days before the Primary Election) (N.J.S.A.19:23-12) and that the said person(s) so endorsed is (are) legally qualified under the law of the State of New Jersey to be nominated for the said office, and a member(s) of the political party named in this petition. We do further certify that the names and post office addresses of the three persons named as a Committee on Vacancies are as follow: (optional see R.S. 19:23-12) The names and residence addresses of the three members named as a committee on vacancies are as follows: Name(s) Residence Address City Zip Code (Please Print or Type) Page 1
STATE OF NEW JERSEY 2018 } Primary Election- 2018 } S.S. COUNTY OF ESSEX } The undersigned being duly sworn upon his or her oath saith that he or she is one of the signers to the foregoing petition; that said petition is signed by each of the signers thereto in his or her own proper handwriting; that each of said signers is to the best of the knowledge and belief of deponent a legal voter of the said County as stated in said petition, and that said petition is prepared and filed in absolute good faith for the sole purpose of endorsing the person(s) therein named in order to secure his, her or their nomination(s) as candidate(s) for office as stated in said petition. Subscribed and sworn to before me } this................. day of }................... A.D. 20.... } (Notary, Attorney, or Officer taking Oath) ( of Petitioner) (Type or of Petitioner) CANDIDATE S REQUEST FOR DESIGNATION ON THE OFFICIAL BALLOT (OPTIONAL) Candidate(s) endorsed for the office mentioned in this petition, does or do hereby request that there be printed opposite his, her or their name or names on the said Primary Ballot the following designation: (Must not Exceed six words and must comply with R.S. 19:23-17) CERTIFICATE OF CONSENT AND QUALIFICATION I, or we the undersigned, hereby certify that I (or) we are members of the political party named in the foregoing petition, I (or) we are qualified for the office of hereinbefore in this petition set forth, that I or we consent to stand at the ensuing Primary Election as Candidate(s) for the nomination(s), and that if nominated, I or we agree the nomination; I (or) we, do further certify that I am (or) we are residents of and am or are legal voter(s) in the County of Essex. ( of Candidate) ( of Candidate) (Type or of Candidate) (Type or of Candidate) ( of Candidate) ( of Candidate) (Type or of Candidate) (Type or of Candidate) Page 12
and residence address of registered voter: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Page 2
and residence address of registered voter: 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. Page 3
and residence address of registered voter: 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. Page 4
and residence address of registered voter: 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. Page 5
and residence address of registered voter: 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. Page 6
and residence address of registered voter: 51. 52. 53. 54. 55. 56. 57. 58. 59. 60. Page 7
PRIMARY ELECTION- 2018 and residence address of registered voter: 61. 62. 63. 64. 65. 66. 67. 68. 69. 70. Page 8
and residence address of registered voter: 71. 72. 73. 74. 75. 76. 77. 78. 79. 80. Page 9
and residence address of registered voter: 81. 82. 83. 84. 85. 86. 87. 88. 89. 90. Page 10
and residence address of registered voter: 91. 92. 93. 94. 95. 96. 97. 98. 99. 100. Page 11
AFFIDAVIT OF PERSON WHO CIRCULATES THIS PETITION AND WITNESSES SIGNATURES (N.J.S.A. 19:23-11) The witness taking the affidavit below must be the person who obtained the names on this set of signatures or several sets of signatures. The witness must take the affidavit for each set he/she solicits and sign in the presence of a person authorized to administer affidavits (e.g., notary public). State of New Jersey : : ss. County of : I,, being duly sworn according to law on my oath or affirmation ( of Circulator/Witness) hereby state that I am a registered voter in this State whose party affiliation is of the same political party named in the petition; that I personally circulated the petition; that the petition is signed by each of the signers thereof in his/her proper handwriting; that to my best knowledge and belief the signers are legal voters of Essex County, and belong to the political party named in the petition; and that the petition is prepared and filed on absolute good faith for the sole purpose of indorsing the person therein named in order to secure his or her nomination or selection as stated in such petition. Sworn and subscribed to before me in N.J., on (List County where Affidavit was signed) ( of Circulator/Witness) this day of (Day) (Residence Address of Circulator/Witness), 20 (Month) (Year) (City or Town of Circulator/Witness (Zip Code) (Notary ) (My Commission Expires) (Place Notary Stamp in the area above) Page 13
OATH OF ALLEGIANCE NOTE: Must be taken by all candidate(s) except optional for Sheriff, County Clerk and Surrogate. See R.S.19:23-15 and 41:1-1 and Court Cases. I, or we, do solemnly swear (or affirm) that I or we will support the Constitution of the United States and the Constitution of the State of New Jersey, and that I or we will bear true faith and allegiance to the same and to the Governments established in the United States and in this State, under the authority of the people; So Help Me God. ( of Candidate) ( of Candidate) (Type or of Candidate) (Type or of Candidate) ( of Candidate) ( of Candidate) (Type or of Candidate) (Type or of Candidate) Subscribed and sworn to before me } this................. day of }................... A.D. 20.... } _ (Notary, Attorney, or Office taking Oath Page 14
NOTICE: All candidates are required by law to comply with the provisions of the New Jersey Campaign Contributions and Expenditures Reporting Act. FOR FURTHER INFORMATION PLEASE CALL (609) 292-8700 OR TOLL FREE WITHIN NJ AT 1-888-313-ELEC (3532). PLEASE READ INFORMATION ON CIRCULATION AND FILING PETITIONS (R.S. 19:23-10) One or more petitions may be circulated and one or more petitions filed on behalf of Candidate(s) providing: 1. All petitions are filed on or before 4:00 P.M. on April 2nd, 2018. The 64th day prior to the election. 2. That in the aggregate the number of valid signers of the petition(s) equal or exceed 100. 3. One or more of the signers of each petition verify the petition on his or her oath or affirmation (19:23-11). 4. The signers are qualified voters and reside in Essex County. 5. The candidates(s) endorsed in the petition fully complete and execute on (or more) petitions with respect to qualifications, consent and acceptance and Oath of Allegiance. (R.S. 19:23-7) NOTICE: All candidates are required by law to comply with the provisions of the New Jersey Campaign Contributions and Expenditures Reporting Act. FOR FURTHER INFORMATION PLEASE CALL (609) 292-8700 OR TOLL FREE WITHIN NJ AT 1-888-313-ELEC (3532). 1. Read carefully and fill in the blanks. 2. Must have 100 or more Legal Voters, Residents of Essex County and Member of same Political Party, sign Petition but may file more than one Petition with a total of 100 or more signatures. 3. Petitioners must SIGN in their own handwriting, PRINT his or her name, giving their residence and Post Office addresses over the words " of Petitioner," in the presence of some one person. 4.The person in whose presence the Petition was signed must sign the Petition and make the affidavit required before some Officer authorized by law to take affidavits. 5. The Candidate or Candidates must sign the Certificate of Acceptance, stating that he or she is qualified for the Office and is a Member of the Political Party named in the Petition. 6. This Petition for candidate(s) for County Officers, State Committee and Delegates to National Conventions when nominated of elected in all or part of Essex County. 7.THIS PETITION MUST BE FILED WITH THE ESSEX COUNTY CLERK'S OFFICE NO LATER THAN 4:00 P.M. ON APRIL 2nd, 2018, THE 64TH DAY PRIOR TO THE ELECTION. Page 15