Author: SLienhard
Last saved by: Richard Lopez
Company: CODOLA

SELF- NOMINATION AND ACCEPTANCE
C.R.S 1-13.5-303; 1-45-109(1)(a)(II); 1-45-110; SOS CPF Rule 16; 1-4-908(1); 1-4-912

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)

whose email address is: ______________________________________		
				(Email Address)
hereby nominate myself and accept such nomination for the office of Director for [a          two-year term*] a           four-year term [for       Director District, if applicable] on the Board of Directors of  the                                                                     District at the regular election on May 2, 2023, and will serve if elected.			
I affirm that I am an eligible elector of the                                                           District and am an eligible elector at the date of signing this Self-Nomination and Acceptance Form (or letter).

Mark here _____ if you are a member of an executive board of a unit owner’s association, as defined in § 38-33.3-103 of the Colorado Revised Statutes, located within the boundaries of the district for which you are running for office. 

I further affirm that I am familiar with the provisions of the Fair Campaign Practices Act as required in § 1- 45-110 of the Colorado Revised Statutes, and I will not, in my campaign for this office, receive contributions or make expenditures exceeding $200 in the aggregate during the election cycle, however, if I do so, I will 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) 

_______________________________________		______________________________________
(Email Address)							(Residence Address) (County) (City/Town, State, Zip Code)

_______________________________________		______________________________________
(Telephone Number)						 (Telephone Number)

Eligibility Section (not required, but helpful for DEO to expedite)
I am an eligible elector because I am registered to vote in Colorado and am (mark one):	

☐	A resident of the District; or

☐	The owner (or spouse/civil union partner of owner) of taxable real or personal property situated within the boundaries of the District, Spouse’s Name, if property is in spouse’s name; or

☐	A person who is obligated to pay taxes under a contract to purchase taxable property within the District.
For Use by the Designated Election Official:

Received on: _______________________, at:_________ Received by: _________________________________                               
			(Date)			(Time)					(Name)

Self-Nomination Form Deemed: 

Sufficient on: ________________________ (Date/Time)
Not Sufficient on: _____________________ Candidate Notified on: ___________________ (Date)              
Received Amended Form on: __________________________ (Date/Time)
Amended Form Sufficient on: __________________________ (Date/Time)	

County in which the district court that authorized the creation of the special district is located: _______________ County.

After review, the DEO shall provide notification of the sufficiency or insufficiency of the candidate; no later than the 67^th day prior to the election.								

***ATTENTION: DO NOT FILE WITH THE SECRETARY OF STATE IF YOUR ELECTION IS CANCELLED!					
Copy sent to Secretary of State on:                           (Date) [If the election is not cancelled, the self-nomination and acceptance form must be filed with the Secretary of State no later than the 60^th day prior to the election, March 3, 2023.].

Division of Local Government-Department of Local Affairs - 2023 Election		    SD-7
Revised 11/2/22
*Rare. Only applies in the event of a vacancy per §32-1-905 for seat elected to three year term in 2022                 Page  of