Filling out and submitting this form asserts the following:

I, the undersigned, declare upon honor, that I reside in the listed City in the State of Evergreen, and am a qualified voter therein; that I hereby declare myself a candidate for the listed office at the general election to be held on the 21st day of June 2023 and hereby request that my name be printed on the official primary ballot, as a candidate of the listed Party*, as provided by law.

FURTHER, I do solemnly swear (or affirm):
That I will support the Constitution and laws of the United States and the Constitution and laws of the State of Evergreen; that I do not advocate the overthrow, destruction, or alteration of the constitutional form of government of the United States or of the State of Evergreen or any political subdivision of either of them, by revolution, force of violence, and that I do not knowingly belong to any organization, foreign or otherwise, which engages in or advocates the overthrow, destruction or alteration of the constitutional form of government of the United States or of the State of Evergreen or any political subdivision of either of them, by revolution, force or violence.