AFFIDAVIT OF INTENT TO BE A WRITE-IN CANDIDATE

C.R.S. 1-13.5-305; 1-4-1101; 1-4-1102(2); 1-4-501; 1-45-109(1)(a)(II); 1-45-110; SOS CPF Rule 16 

I,  
       		(full name of the candidate) 

who reside at:	______________________________________
		(Residence Street Name and Number)

		______________________________________
		(City or Town, Zip Code)

		______________________________________
		(County, State)

		______________________________________
		(Mailing Address, if different from residence address)

whose email address is: ______________________________________		
				(Email Address)
whose telephone number is: ______________________________________		
				(XXX) XXX - XXXX

desire the office of *Director for a          two-year/ a           four-year term [for       Director District, if applicable] on the Board of Directors of the                                                                 District at the regular election on May 2, 2023, and am qualified to assume the duties of the office if elected and will serve as Director if elected.			

I further affirm that I am familiar with the provisions of the Fair Campaign Practices Act as required in § 1- 45-110 of the Colorado Revised Statutes, I will not, in my campaign for this office, receive contributions or make expenditures exceeding $200 in the aggregate during the election cycle, however, if I do so, I will thereafter file all disclosure reports required under the fair campaign practices act.

DATED   this            day of                           , 20     .		WITNESSED by the following registered elector:

_______________________________________		______________________________________
(Signature of Candidate)						(Signature of Witness)

_______________________________________		______________________________________
(Printed Full Name of Candidate)					(Printed Full Name of Witness)

_______________________________________		______________________________________
(Email Address)							(Residence Address)

_______________________________________		______________________________________
(Telephone Number)						(City or Town, Zip Code)

[Continued on next page]

Before me,                                          , a notary/officer duly authorized to administer oaths, in and for said State, personally appeared                                          , whose name is subscribed to the forgoing Affidavit of Intent to Be A Write-In Candidate, and who being first duly sworn, upon oath says, that the foregoing statements are true and he/she acknowledges the execution of said instrument to be of his/her own free act and voluntary deed for the uses and purposes therein set forth.  

Subscribed and affirmed to before me this                 day of                                  , 20          .

STATE OF COLORADO
COUNTY OF 

Seal								           
(Notary/Official Signature)

My Commission Expires	 			                                                                 	
											(Title)

Eligibility Section (not required, but helpful for DEO to expedite)
I am an eligible elector because I am registered to vote in Colorado and am (mark one):	

	A resident of the District; or

	The owner (or spouse/civil union partner of owner) of taxable real or personal property situated within the boundaries of the District, Spouse’s Name, if property is in spouse’s name; or

	A person who is obligated to pay taxes under a contract to purchase taxable property within the District.

AFFIDAVIT OF INTENT TO BE A WRITE-IN CANDIDATE, continued
PROCEDURAL INSTRUCTIONS:  This is a sample form only.  Review use with attorney.  The Affidavit of Intent shall be filed by the close of business on the sixty-fourth day before the election.  The DEO will prepare a list of the names of the individuals who filed the affidavit of intent for use by the judges at the polling place.   

For Use by the Designated Election Official:
Received on:                (Date), at:             (Time) Received by:                  (Name) 
County in which the district court that authorized the creation of the special district is located: _______________ County.
Copy sent to Secretary of State on:                  (Date) [no later than 60 days before election only if election will not be cancelled, March 3, 2023] 

***ATTENTION: DO NOT FILE WITH THE SECRETARY OF STATE IF YOUR ELECTION IS CANCELLED!