Candidate Statement Form Decline to File
NOVEMBER 5, 2024, GENERAL ELECTION
Name of Candidate as it will appear on ballot
Office Sought
Mailing Address
City
State
Zip
☐ I DO NOT ELECT TO FILE A CANDIDATE STATEMENT
Signature of Candidate
Date
IF I ELECT TO FILE A CANDIDATE STATEMENT BY 4 PM on AUGUST 9 , 202 4 : • I have read the Candidate Statement section(s) of the Registrar of Voters Candidate Filing Guide for this election and affirm that my candidate statement as submitted on this form complies with the California Elections Code and the Registrar of Voters policies. • I have been informed that the estimated cost and deposit for my candidate statement is $ • I agree that if the actual cost of the candidate statement exceeds the amount paid in advance, I will pay the additional sum to San Bernardino County within 30 days of the billing notification for such amount. • I agree that if the amount billed is not paid within 30 days following such notification, and the Elections Official thereafter commences legal action against me for the recovery of said amount, I will pay all costs of such action, including costs and reasonable attorney's fees in an amount to be fixed by the court. • I have been informed that if the amount paid in advance is more than the actual cost of the candidate statement, the Elections Official will refund the excess amount within 30 days of the election. • I have been informed that refunds will not be issued if voters receive mail ballots prior to receiving the San Bernardino County Voter Information Guide. • I agree that any notice, refund or billing pertaining to my candidate statement shall be mailed to me at the address set forth above and shall be deemed completed upon deposit in the United States mail. • I have been informed that State Senate and State Assembly candidates are required to accept the voluntary campaign expenditure limits on FPPC form 501 in order to have a candidate statement printed in the San Bernardino County Voter Information Guide. • I have been informed that I may withdraw my candidate statement no later than 5:00 p.m. of the next working day after the close of the candidate filing (nomination) period. Signature of Candidate Acknowledging the Above Date
If you have any questions or concerns, please contact us via phone at (909) 387-8300 or via email at CandidateFiling.ROV@rov.sbcounty.gov
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