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To the Maricopa County Board of Supervisors:

I, Craig Berland, Chairman of the Maricopa County Republican Party, hereby submit the name of the following Maricopa County voter for appointment as a Precinct Committeeman for the Republican Party to be approved by the Board. I attest that, to the best of my knowledge and belief, this voter meets the statutory and applicable by-law requirements to be appointed and serve as a Precinct Committeeman for the relevant precinct.

Appointee is nominated to serve in:

Precinct Number*

Precinct Name*

Voter to be appointed:

Name as appears on voter registration*

Residential Address including city state zip code*

Mailing Address if different*

Voter ID Number*

Congressional District*

Legislative District*

Supervisorial District*

Telephone*

Email Address*

example@example.com

Signature of Appointee*

Date*

Date