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Write-in Candidate Declaration of Intent instructions When to file By 4 p.m. on the second Friday immediately preceding the election, except precinct delegates. Delegates can file by 4 p.m. on the first Friday immediately preceding the election or on Election Day at the precinct. Where to file • File with the Michigan Bureau of Elections for a federal or state district that includes more than one county (including statewide) and all judicial races except probate or municipal. • File with the county clerk for a federal or state district in only one county, a county or probate judge race, and precinct delegates. • File with the city or township clerk for all city or township offices. • Contact your county clerk to determine the appropriate filing official for village, school, or library district offices. Campaign finance You may have additional filing obligations under Michigan’s Campaign Finance Act. Ask your filing official. Completing the form Section 1: Write-in candidate information Section one requires you to provide your information. You may provide a mailing address to receive your ballot proof and other information at an alternate address. Please provide a phone number and email address so your filing official may contact you. Section 2: Office information Section two requires detailed information for the office you seek. All office details are required. • First, provide the name of the office you seek as well as the jurisdiction, and any district/ward defining the office you seek. Precinct delegates place the precinct number on the line provided. • Next, mark your political party affiliation. If running for a partisan office, list your political party in the space provided. • Third, provide the date of the primary and general election if you intend to run in both elections. If you are filing only for the November general election, only complete the general election date. • Fourth, select the term of office. If it is a partial term, you must indicate when the partial term is expiring. • Fifth, judicial candidates only, must mark whether the position is incumbent, non-incumbent or a new judgeship. Section 3: Statement Sign and date the affidavit in front of a notary and complete the notarization. Write-In Candidate Declaration of Intent (Rev. 10/23) 1 ---PAGE BREAK--- Write-In Candidate Declaration of Intent (Rev. 10/23) 2 Write-in Candidate Declaration of Intent SECTION 1 Write-in candidate information First name Middle name Last name Residential address City ZIP Mailing address, if different than above City ZIP Phone number Year of birth Email address Campaign website SECTION 2 Office information Office name Jurisdiction District/circuit/ward If precinct delegate, provide the precinct number I am running for a partisan office, and my political party is I am running for a nonpartisan office without party affiliation I am running for a partisan office without party affiliation Election (check one) Primary election date (mm/dd/yyyy) General election date (mm/dd/yyyy) Term (check one) Regular term Partial term expiring date (mm/dd/yyyy) Recall Judicial candidates only Incumbent position Non-incumbent position New judgeship Select one SECTION 3 Statement By signing this affidavit, I swear the statements made above are true and do hereby declare my intent to seek the above elective office as a write-in candidate. Candidate signature Date Notary signature Notary name County of commission Acting in the County of My commission expires date (mm/dd/yyyy) Date of notarization date (mm/dd/yyyy) Office use only Date of filing Received by Reviewed by Campaign finance number CLEAR FORM