Presidential Elector Consent

Presidential Elector Consent and Certification of Voter Registration

(For the November 8, 2016 General Election)

Name of Presidential Candidate: ______

(Please print.)

Name of Vice-Presidential Candidate: ______

(Please print.)

Legal name of candidate for Presidential Elector:

______

(Last name and suffix, if any) (First name) (Middle name or initial)

Residence Address of Candidate: ______

(Street Name and Number - not P.O. Box) (City, Town, or Plantation; Zip Code)

Mailing Address of Candidate: ______

(Complete if different from above address)

Representing: c First Congressional District c Second Congressional District c At-Large

Qualifications of Presidential Elector (U.S. Constitution, Article II, Section 1

and 21-A MRS Section 352)

As of August 1, 2016, the candidate for the office of presidential elector must:

§ be a resident of and a registered voter in the electoral division which the elector seeks to represent (as indicated above); and

§ maintain a voting residence in that electoral division during the elector’s term of office.

The following people are not eligible to be appointed an Elector:

§ United States Senator,

§ Representative to Congress, and

§ Any person holding an Office of Trust or Profit under the United States.

Elector’s Consent

I hereby declare my consent to accept this nomination. I further declare that I reside in the municipality listed

above, that I am qualified to hold this office, and that this declaration is true.

______

(Signature of Candidate)

Subscribed to and sworn before me on this date: ______

(Date) (Signature of Notary Public)

______

(Printed Name of Notary Public)

I hereby certify that, ______, is a registered voter in this

(Name of Elector)

municipality as of this date.

______

(Date) (Signature of Municipal Registrar/Clerk)

______

(Name of Town, City or Plantation)

Revised 7/12