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Affidavit of Identity and Receipt of Filing instructions When to file All affidavits must be received by the filing deadline on the date and time specified at Michigan.gov/elections. Affidavits received after the deadline will be rejected regardless of postmark. Where to file • File with the Michigan Bureau of Elections for a federal or state office that includes more than one county, and all statewide offices. This excludes judicial candidates who must use the Non-Incumbent Judicial Affidavit of Identity and Constitutional Qualification or Incumbent Judicial Affidavit of Identity and Affidavit of Candidacy. • File with the county clerk for a federal or state district that is entirely contained in one county. Note: Judicial candidates should use the Non-Incumbent Judicial Affidavit of Identity and Constitutional Qualification Form or the Incumbent Affidavit of Identity and Affidavit of Candidacy forms. Precinct Delegates should use the Precinct Delegate Affidavit of Identity. • File with the city or township clerk for all city or township offices. Withdrawing your filing The deadline for withdrawing is three days after the filing deadline. Once filed, an affidavit of identity may not be altered. If changes are needed, an entirely new affidavit must be filed. Completing the form Section 1: 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. If you are using a name that was not provided to you at birth, you must check the box and provide your former name. However, you do not need to provide a former name if your name changed due to marriage or divorce, or formally for any reason more than 10 years ago, or if you are using your common law name. Section 2: Office and ballot 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. • 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, indicate exactly how you want your name to appear on the ballot using upper and lowercase letters. You may not use nicknames or titles (e.g. Dr., PhD, etc). • Sixth, indicate your filing method. If filing with petitions, state whether you want your petitions returned to you in January or if they can be destroyed. Section 3: Certification and attestation • If you previously ran for office and filed campaign finance reports with the county, you must list each county. • If you previously ran for office and filed campaign finance reports with the Secretary of State, indicate “state.” • If you have not previously run for office, or ran for office but were not required to file campaign finance reports, you may leave this section blank. Sign and date the affidavit in front of a notary and complete the notarization. By signing you are certifying: all statements, reports, late filing fees and fines have been filed or paid; you are a United States Citizen; acknowledgment that making a false statement in this affidavit is perjury and punishable by law. To be placed on the ballot, you must not have any outstanding fines, fees, or reports required to be filed or paid under the Michigan Campaign Finance Act. Affidavit of Identity and Receipt of Filing Rev. (04/25) 1 ---PAGE BREAK--- Affidavit of Identity and Receipt of Filing All information must be completed unless otherwise noted. Missing or incorrect information may result in disqualification. Judicial candidates should use a combined judicial affidavit of identity/qualification form rather than this form. SECTION 1 Candidate information First name Middle name Last name Year of birth My name has formally changed in the last 10 years for a reason other than marriage or divorce. My former name is: Residential address City ZIP Mailing address, if different than above City ZIP Phone number Email Campaign website, if applicable SECTION 2 Office & ballot information Office name Jurisdiction District/Ward I am running for a partisan office, and my political party is: I am running for a nonpartisan office without party affiliation (judicial office: see note above) I am running for a partisan office without party affiliation. Primary election date (mm/dd/yyyy) General election date (mm/dd/yyyy) Term of office (select one): Regular term Partial term expiring: date (mm/dd/yyyy) Recall Indicate exactly how you want your name to be printed on the ballot (use upper and lowercase letters): Filing method (Select one): Petitions Return to me in January Destroy in January $100 filing fee (if applicable) Certification of party nomination and certificate of acceptance (if applicable) Select one SECTION 3 Certification & attestation I previously ran in Michigan for office that required filing reports under the Michigan Campaign Finance Act. I ran in the following counties By signing, I certify that: • At this date, all statements, reports, late filing fees, and fines required of me or any candidate committee organized to support my election under the Michigan Campaign Finance Act have been filed or paid; and • I am a United States citizen and meet the statutory and constitutional requirements for the office sought; and • I acknowledge that making a false statement in this affidavit is perjury - a felony punishable by a fine up to $1,000 or imprisonment for up to five years or both and may result in disqualification from the ballot. 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 (mm/dd/yyyy) Affidavit of Identity and Receipt of Filing Rev. (04/25) 2 Office use only Date of filing (mm/dd/yyyy) Received by date (mm/dd/yyyy) Reviewed by Check number Number of petition sheets Campaign Finance Number CLEAR FORM