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SECTION 1: Petion Request
We, the undersigned, being duly registered voters in the District of Columbia who are US citizens, request that the District of Columbia Board of Elections place the name of the individual nominated by this petition on the November 3, 2026 General Election ballot.
SECTION 2: Instructions to the Circulator (you)
Validity of Signatures:
1. At the time this petition is signed, each signer must be registered to vote at the address listed on the petition page. If the signer is registered at a District address other than the one listed on the petition, and their signature is challenged on that basis, the signer must file a change of address within ten (10) days after the date the candidate receives notice that a challenge has been filed to the nominating petition or the signature will not be counted.
2. The signer’s printed name and address, as well as the date that the signer signed the petition, must appear in the spaces provided.
3. As the circulator of this petition sheet, you must personally witness the signing of each signature that appears on this petition, and you must swear or affirm that you have done so in the circulator’s affidavit below. 4. No person other than the petition signer may write, alter, correct, or clarify any information about the petition signer unless the signer requests assistance before the signer affixes their signature. 5. Attach a Signature Attestation Form for each signer that is unable to independently sign the nominating petition, due to an injury or disability.
Filing Deadline: The deadline to file this petition is 5:00 p.m. on Wednesday, August 5, 2026. The petition must contain the minimum number of signatures required by law. Supplemental petition sheets may be filed, but only after the candidate has made an initial filing containing the minimum number of signatures. Petitions must be filed in person at the D.C. Board of Elections, 1015 Half Street, SE, Suite 750.
SECTION 3: Required Affidavits
1. At the time the initial submission is filed, the person filing must complete an affidavit attesting that the petition contains the minimum number of signatures.
2. The candidate’s signed and notarized Declaration of Candidacy must be filed when their petition is issued.
3. For the affidavit below, only one circulator signature should be affixed to the petition sheet; and the circulator’s signature and date should not pre-date those of the registered voters who sign the sheet. Filing Deadline: The deadline to file this petition is 5:00 p.m. on Wednesday, August 5, 2020. The petition must contain the minimum number of signatures required by law. Supplemental petition sheets may be filed, but only after the candidate has made an initial filing containing the minimum number of signatures. Petitions must be filed in person at the D.C. Board of Elections, 1015 Half Street, SE, Suite 750.
Required Affidavits: 1. At the time the initial submission is filed, the person filing must complete an affidavit attesting that the petition contains the minimum number of signatures. 2. If the candidate has not already filed a signed and notarized Declaration of Candidacy, one must be filed at the time the petition is submitted. 400 Galloway St. NE, Apt 450S 20011 ____________________________________________________________________________________________________________ CANDIDATE’S ADDRESS (INCLUDING ZIP CODE) 120012313 Independent ____________________________________________________________________________________________________________ VOTER REGISTRATION NUMBER PARTY AFFILIATION
CIRCULATOR’S AFFIDAVIT (TO BE COMPLETED BY PERSON CIRCULATING THIS PETITION PAGE) I, _______________________________________, residing at ___________________________________________________________________________________, Printed Name of Circulator Address of Circulator swear or affirm:
(a) that I am at least at least 17 years of age and will be 18 years of age on or before the next general election;
(b) that I am either a resident of the District of Columbia or a resident of another jurisdiction who registered as a petition circulator with the Board prior to the circulation of this petition sheet;
(c) that I personally circulated this petition sheet;
(d) that I personally witnessed the signing of each signature hereon;
(e) I have not written, altered, corrected, clarified, or obscured information on the petition about the signer of the petition after the signer affixed their signature to the petition; and
(f) that I have personally inquired from each signer whether the signer is a duly registered voter in the District of Columbia.
WARNING! READ THE ABOVE AFFIDAVIT AND MAKE SURE IT IS TRUE BEFORE YOU SIGN BELOW. IF YOU ARE CONVICTED OF MAKING A FALSE STATEMENT, YOU CAN BE FINED UP TO $1,000 AND/OR JAILED UP TO 180 DAYS [D.C. OFFICIAL CODE SECTION 22-2405(b)]. ___________________________________________________________________________________________________________________________________________ Signature of Circulator Date Circulator’s Telephone Number (Optional)
Sign the digital form. Not here.
Sign the digital form. Not here.
Sign the digital form. Not here.
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