That the following named persons, or

Committee, shall constitute a vacancy committee in and for the --Party, of the‒‒‒‒

(State) (District) or (County)

and be empowered to fill any vacancy that may occur in the designation made by the Assembly, viz.:-.

Personally appeared before me, a Notary Public, in and for

the said County of..

State of Colorado,-.

(Name of Chairman or Presiding Officer of Assembly)

and

(Name of Secretary of Assembly)

who being first duly sworn each for himself and not one for the other, upon oath deposes and says; that the said__

was the Chairman and Presiding Officer of the.. Assembly, held in the City of.

State of Colorado, on

A. D. 19‒‒‒‒; and the said.

(Date of holding Assembly)

County

was the Secretary thereof; that the above Certificate of Designation and the statements contained therein are true to the best of their knowledge and belief.

(All Petitions or forms under Primary Election Law must be uniform in size and color, 17x11 inches, white paper, printed or written in black ink.)

FORM P. E. NO..........

DECLARATION OF ACCEPTANCE OF DESIGNATION BY ASSEMBLY.

To the Hon.:

(Secretary of State) (County or City Clerk) or (other Officer with whom Certificate of Designation by Assembly is filed).

.Colorado,

This is to certify that I,---

do hereby accept the Designation of the_-_-.

Assembly, held at__

day of

.on_.

19----, as evidenced by the Certifi

cate of Designation of said Assembly, duly filed in the office of

on the__.

(Secretary of State) (County or City Clerk)

--day of___

19----, in accordance with the provisions of the Primary Election Law of 1910-Election Laws 1916, Page 32-as a candidate for the office of

to be voted upon at the ensuing Primary Election to be held on the__. -day of September, A. D. 19____.

Before me,-

--9

--, a Notary Public

within and for said County and State, personally appeared_--who, being duly sworn says, that the foregoing Acceptance of Designation by Assembly is true and that he has subscribed his signature to the same and acknowledges the same as his free and voluntary act for the uses and purposes therein set forth.

(SEAL)

Notary Public.

(All Petitions or forms under Primary Election Law must be uniform in size and color, 17 x 11 inches, white paper, printed or written in black ink.)

FORM P. E. NO......

X

BIND HERE

-X

STATE OF COLORADO

INDEPENDENT NOMINATION CERTIFICATE.

(For number of signers, where and when filed and committee on vacancies, see Section 26, Primary Election Law, Pages 47 and 48, Election Laws 1916.)

To the Hon.__.

(Secretary of State of Colorado) or (City or County Clerk of City or County of.........

..)

We, the undersigned duly qualified electors and legal voters of the State of Colorado, residing within the_

(State, District, County,

City or other political division, in or for which the officer or officers are to be

representing

elected)

(the political or other name which the signers shall select in not more than five words)

in accordance with the provisions of Section 26 of the Primary Election Laws of 1910: An Act concerning Nominations of Candidates for public offices, and for political party positions, etc., Approved Oct. 17, 1910-hereby make the following nominations for offices to be filled at the next ensuing--Election, to be held on the______. --day of___

A. D. 19----,

we do hereby designate and appoint the following named persons as a Committee for the above__

(Name signers adopted)

to fill any and all vacancies which may occur in said nominations, caused by death, resignation or otherwise:

NAMES OF CANDIDATES AND OFFICES TO BE FILLED.

Office to Be Filled

Name of P. O. Place of Residence Place of Business
Candidate Address

(If in a City)
(St. and No.)

(If in a City) (St. and No.)

Before me,

a Notary Public, within and for said County and State, personally appeared each and every one of the persons whose names are signed to the foregoing Certificate, and being first duly and severally sworn each for himself or herself, deposes and says that he or she is a legal voter in the

(Name of Political Division for which Nominations are made)

and that he or she signed the said Certificate and has correctly stated his or her place of residence by adding the same to his or her said signature, and that he or she has not voted at any Primary Election to nominate a candidate for such office or any of such officers.