SELF - NOMINATION AND ACCEPTANCE
32-1-804.3; 1-4 501; 1-45-109(1); 1-45-110; SOS CPF Rule 8; 1-5-203(3); 1-4-912; C.R.S.
I, __________________________________________________________________________________________
(full name of the candidate as the name will appear on the ballot, cannot use titles such as "MD',
Reverend", or "Chief"
who reside at: __________________________________________
(residence street name and number)
__________________________________________
(city or town, zip code)
__________________________________________
(county), (state)
__________________________________________
(mailing address if different from residence address)
hereby nominate myself and accept such nominations for a x four-year term on the Board
of Directors of the Central Orchard Mesa Fire Protection District at the regular election on May
20, 2010, and will serve if elected.
I affirm that I am an eligible elector of the Central Orchard Mesa Fire Protection District and am an
eligible elector at the date of signing this Self-Nomination and Acceptance Form (or letter).
I am an eligible elector because I am registered to vote in Colorado and am (mark one):
_________ A resident of the District, or area to be included in the district, for not less then 30 days; or
_________ The owner (or spouse of owner) of taxable real or personal property situated within the
boundaries of the District.
_________ A person who is obligated to pay taxes under a contract to purchase taxable propery with the
District.
I further affirm that I am familiar with the provisions of the Fair Campaign Preactices Act as
required in 1-45-110 of the Colorado Revised Statutes, and I shall not, in my campaign for
this office, receive contributions or make expenditures exceeding twenty dollars ($20) in the
aggregate; however, if I do so, I shall thereafter file all disclosure reports required under the
Fair Campaign Practices Act.
Dated this _____ day of ____________. 20____ WITNESSED by the following registered elector;
___________________________________ _________________________________
(Signature of Candidate) (Signature of Witness)
___________________________________ _________________________________
(Printed full name of Candidate) (Printed full Name of Witness)
_________________________________
___________________________________ (Residents Street Name and Number)
(Telephone Number) _________________________________
(City or Town, Zip Code)
_________________________________
(County)
_________________________________
(Telephone Number
DIVISION OF LOCAL GOVERNMENT-DEPARTMENT OF LOCAL AFFAIRS-2010 EDITION B-9
Revised 6/12/2009 Page 1 of 2
32-1-804.3; 1-4 501; 1-45-109(1); 1-45-110; SOS CPF Rule 8; 1-5-203(3); 1-4-912; C.R.S.
I, __________________________________________________________________________________________
(full name of the candidate as the name will appear on the ballot, cannot use titles such as "MD',
Reverend", or "Chief"
who reside at: __________________________________________
(residence street name and number)
__________________________________________
(city or town, zip code)
__________________________________________
(county), (state)
__________________________________________
(mailing address if different from residence address)
hereby nominate myself and accept such nominations for a x four-year term on the Board
of Directors of the Central Orchard Mesa Fire Protection District at the regular election on May
20, 2010, and will serve if elected.
I affirm that I am an eligible elector of the Central Orchard Mesa Fire Protection District and am an
eligible elector at the date of signing this Self-Nomination and Acceptance Form (or letter).
I am an eligible elector because I am registered to vote in Colorado and am (mark one):
_________ A resident of the District, or area to be included in the district, for not less then 30 days; or
_________ The owner (or spouse of owner) of taxable real or personal property situated within the
boundaries of the District.
_________ A person who is obligated to pay taxes under a contract to purchase taxable propery with the
District.
I further affirm that I am familiar with the provisions of the Fair Campaign Preactices Act as
required in 1-45-110 of the Colorado Revised Statutes, and I shall not, in my campaign for
this office, receive contributions or make expenditures exceeding twenty dollars ($20) in the
aggregate; however, if I do so, I shall thereafter file all disclosure reports required under the
Fair Campaign Practices Act.
Dated this _____ day of ____________. 20____ WITNESSED by the following registered elector;
___________________________________ _________________________________
(Signature of Candidate) (Signature of Witness)
___________________________________ _________________________________
(Printed full name of Candidate) (Printed full Name of Witness)
_________________________________
___________________________________ (Residents Street Name and Number)
(Telephone Number) _________________________________
(City or Town, Zip Code)
_________________________________
(County)
_________________________________
(Telephone Number
DIVISION OF LOCAL GOVERNMENT-DEPARTMENT OF LOCAL AFFAIRS-2010 EDITION B-9
Revised 6/12/2009 Page 1 of 2
For Use by the Designated Election Official;
Received on:________________________ (Date), at:___________ (Time) Received by:__________________ (Name)
Self-Nomination Form Deemed:
Sufficient on: _______________________________.
Not Sufficient on: ________________ Candidate Notified on: __________________ (Date)
Received Amended Form on: _____________________ (Date/Time)
Amended Form Sufficient on: _____________________ (Date/Time)
Copy Sent to Clerk & Recorder on: ________________ (Date)(Deadline to send to county clerk is no late the 60 days
before election)
Please note that starting January 1, 2010, all Campaign Political Finance fillings will be handled by the Secretary of
State's office rather than the counties.
PROCEDURAL INSTRUCTIONS: This is a sample form only, Review use with your attorney. An eligible elector may
submit a letter to the DEO in lieu of this form. The letter must have the same information in it. As most candidates
do not know the Fair Campaign Practices Act requirements, it is strongly suggested that the DEO require candidates
to use this form. This form must be filed with the Designated Election official (DEO) of the District not less then 67
days prior to the regular election. While the deadline for filing is 67 days before the election (close of business), the
deadline by which any insufficiency must be cured is 3:00 p.m. on the deadline date (1-4-912 CRS). To ensure time
to amend the form if it is not sufficient, it is strongly recommended that prospective candidates submit their
Self-Nomination form earlier than the deadline. The DEO may offer the candidate some proof of filing the form,
perhaps with a photocopy fo the submitted form. The DEO must verify the elector's eligibility )4-4-908. 1-1-104(35),
CRS) Inactive voter status does not disqualify a candidate (1-2-605(3), CRS). To meet Fair Campaign Practices Act
requirements, the DEO must file copies of the Self Nomination forms or a list of the names of all valid candidates
witht he Secretary of State no later then 60 days before the election (SOS CPF Rule 8). The forms are public records
(1-4-504, CRS).
** Important** As of January 1, 2010 all Campaign Finance Filings will be with the SOS rather than with the counties.
Please refer to the Secretary of State's webpage for information on how to file or contact the support team at
cofhelp@sos.state.co.us or 303-894-2200, extension 6383.
DIVISION OF LOCAL GOVERNMENT-DEPARTMENT OF LOCAL AFFAIRS-2010 EDITION B-9
Revised 6/12/2009 Page 2 of 2
Received on:________________________ (Date), at:___________ (Time) Received by:__________________ (Name)
Self-Nomination Form Deemed:
Sufficient on: _______________________________.
Not Sufficient on: ________________ Candidate Notified on: __________________ (Date)
Received Amended Form on: _____________________ (Date/Time)
Amended Form Sufficient on: _____________________ (Date/Time)
Copy Sent to Clerk & Recorder on: ________________ (Date)(Deadline to send to county clerk is no late the 60 days
before election)
Please note that starting January 1, 2010, all Campaign Political Finance fillings will be handled by the Secretary of
State's office rather than the counties.
PROCEDURAL INSTRUCTIONS: This is a sample form only, Review use with your attorney. An eligible elector may
submit a letter to the DEO in lieu of this form. The letter must have the same information in it. As most candidates
do not know the Fair Campaign Practices Act requirements, it is strongly suggested that the DEO require candidates
to use this form. This form must be filed with the Designated Election official (DEO) of the District not less then 67
days prior to the regular election. While the deadline for filing is 67 days before the election (close of business), the
deadline by which any insufficiency must be cured is 3:00 p.m. on the deadline date (1-4-912 CRS). To ensure time
to amend the form if it is not sufficient, it is strongly recommended that prospective candidates submit their
Self-Nomination form earlier than the deadline. The DEO may offer the candidate some proof of filing the form,
perhaps with a photocopy fo the submitted form. The DEO must verify the elector's eligibility )4-4-908. 1-1-104(35),
CRS) Inactive voter status does not disqualify a candidate (1-2-605(3), CRS). To meet Fair Campaign Practices Act
requirements, the DEO must file copies of the Self Nomination forms or a list of the names of all valid candidates
witht he Secretary of State no later then 60 days before the election (SOS CPF Rule 8). The forms are public records
(1-4-504, CRS).
** Important** As of January 1, 2010 all Campaign Finance Filings will be with the SOS rather than with the counties.
Please refer to the Secretary of State's webpage for information on how to file or contact the support team at
cofhelp@sos.state.co.us or 303-894-2200, extension 6383.
DIVISION OF LOCAL GOVERNMENT-DEPARTMENT OF LOCAL AFFAIRS-2010 EDITION B-9
Revised 6/12/2009 Page 2 of 2
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