8/13/2019 Qualification form - Alabama Democratic Party

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THE ALABAMA DEMOCRATIC PARTYDeclaration of Candidacy

STATE OF ALABAMA

COUNTY OF ________________________________________________________________________

I hereby certify that I am a Democrat and that I subscribe to the Principles of the Democratic Party of Alabama. I hereby

certify that I am a qualified elector of the State of Alabama, that I possess the qualifications fixed by law for the office for which I am

a candidate, and will in no way be disqualified from the same. If I am a candidate for the Democratic nomination for Judge of a Court

Record, I hereby certify that at the time of filing this Declaration of Candidacy I am not under disbarment or suspension.

I hereby declare myself to be a candidate for the __________________ Democratic nomination and election for the office of:Year

___________________________________________________________________________Office District, Circuit and/or County Place Number, if applicable

Name to appear on ballot: ______________________________________________________________________Please print or type name without titles as you wish it to appear on the ballot. Name changes will not be accepted after the close of qualifying.

For Party Office Use Only:

Date Recd

Amt. Pd.Receipt #

Pmt. Type

Data Entry

_________________________________________________________________Signature of Candidate

_________________________________________________________________

Print Full Name of Candidate

Sworn and subscribed before me on this the _________________ day of

_____________________________________________, __________________.

_________________________________________________________________

Notary Publics Signature

_________________________________________________________________

Print Notarys Name Date Commission Expires

_________________________________________________________________

Residential Address

_________________________________________________________________Residential City, State, Zip

_________________________________________________________________

Home Phone Work Phone

_________________________________________________________________

Email Address Cell Phone

_________________________________________________________________Occupation Fax Number

_________________________________________________________________

Employer or Principal Place of Business

_________________________________________________________________

Business Address

_________________________________________________________________Business City, State, Zip

WHITE COPY Original for State Party for State Offices, or County Party

for Local Offices with County Party faxing copy to (334) 262-6474.YELLOW COPY Filed with Secretary of State by State Party for State

Offices, or with Probate Judge by County Party for Local Offices.

PINK COPY Candidates Copy.

Check eachparagraph below that applies regarding the Statement of Economic Interests.I hereby certify that I am an incumbent elected official, or a current state or municipal employee, and/or I already have a

current Statement of Economic Interests on file with the Alabama Ethics Commission.

I hereby certify that I am filing simultaneously with this qualifying paper a Statement of Economic Interests with the

Democratic Party such that they may, as required by law, forward the report to the Alabama Ethics Commission. As a

safeguard to insure timely compliance, I certify that I will file a duplicate copy directly with the Alabama Ethics Commissionwithin the 5 day time period [Alabama Code Section 36-25-15].

I hereby certify that I am a non-incumbent candidate for a judicial position and that I will file a copy of my Statement of

Economic Interests with the Clerk of the Supreme Court within 10 days of qualifying as a candidate [Canons of JudicialEthics, Canon 6, Subsection C].

Checkonly oneparagraph below that applies regarding Section 4 of the Fair Campaign Practices Act of 1988.I hereby certify and declare that I appoint myself (and hereby accept the appointment) as the sole and only person or

committee to receive, expend, audit and disburse all monies contributed, donated, subscribed, or in any way furnished orraised for the purpose of aiding or promoting my nomination or election as such candidate for said office.

I hereby certify that I will, within five days after filing this Declaration of Candidacy, file with the Secretary of State and/or

Probate Judge as a supplement to this form giving the appointments and acceptances of my Campaign Finance Committee.