2022 Jeffco ExCom GOP Qualifying

DECLARATION OF CANDIDACY

I hereby declare that I am a candidate for 2022 Republican nomination for election to the office of:
Jefferson County Republican Executive Committee, At-Large/District # and Place # *
I certify that:

(1) I possess the qualifications fixed by law for said office and will in no way be disqualified from the same,

(2) I am not subject to disqualification from registering and voting under the laws or the Constitution of the State of Alabama,

(3) I have not been convicted of a felony under the lawss of the United States or of another State and,

(4) I am a Republican and I endorse and will actively support the principles and policies of the Republican Party.
On this date *

Month Day Year
Date
Name *

First Name Last Name
Residence Address (No P.O. Boxes) *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home Phone *
Please enter a valid phone number.
Work Phone
Please enter a valid phone number.
Cell Phone
Please enter a valid phone number.
Email *
example@example.com
NAME AS YOU WISH IT TO APPEAR ON BALLOT- NO TITLES *
Signature *

Clear
Should be Empty:

DECLARATION OF CANDIDACY