Form No. 3-I Prescribed by Secretary of State (03-09)
NOMINATING PETITION AND STATEMENT OF CANDIDACY
FOR JUDGE OR CLERK OF THE MUNICIPAL COURT
To be filed with the Board of Elections not later than 4 p.m. of the day before the primary election.
Revised Code 1901.07, 1901.31, 3501.38, 3513.261
NOTE – THE CANDIDATE MUST FILL IN, SIGN AND DATE THIS STATEMENT OF CANDIDACY
BEFORE PETITIONS ARE CIRCULATED.
STATEMENT OF CANDIDACY
I, _____________________________________________, the undersigned, hereby declare under penalty of
(Name of Candidate)
election falsification that my voting residence address is__________________________________________,
(Street and Number, if any, or Rural Route Number)
________________________________, Ohio _______________; and I am a qualified elector.
(City or Village)
(Zip Code)
I further declare that I desire to be a candidate for election to the office of ____________________________
(Insert “Judge”, or “Clerk”)
of the __________________________________Municipal Court for the:
(check one and fill in the appropriate date)
full term commencing _____________________, or
unexpired term ending ____________________,
in _____________________________ County, Ohio at the general election to be held the _______________
day of ____________________, ___________.
I further declare that I am an elector qualified to vote for the office I seek.
Dated this ______ day of _______________________, _____________.
________________________________________________
(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
(Name of Candidate)
represent me:
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 candidate for election to the office of ______________________of the __________________________
(Insert “Judge”, or “Clerk”)
Municipal Court, for the:
full term commencing ________________,
(check one and fill in the appropriate date)
or
unexpired term ending _________________________, to be voted for at the next general election, and
certify said person is, in our opinion, well qualified to perform the duties of the office or position to which
the person desires to be elected.
Signatures on this petition must be from only one county and must be written in ink.
VOTING RESIDENCE
CITY, VILLAGE
DATE OF
SIGNATURE
ADDRESS
COUNTY
OR TOWNSHIP
SIGNING
STREET AND NUMBER
1.
2.
3.
4.