State of California
County of
}
ss.
I do hereby solemnly declare that I will support the Constitution of the United States and the Constitution of the State of California, and that I will to the best of my ability, faithfully discharge the duties of counting board member for the counting board number _____ for the election to be held on _____, 20 ___.
Signed in the presence of _____ (Signature) _____ on _____, 20 ___.
Cal. Code Regs. Tit. 2, § 20300
Note: Authority cited: Section 12172.5, Government Code; and Section 15270.2, Elections Code. Reference: Sections 12320, 15102, 15270, 15270.1, 15270.3, 15271, 15272, 15273, 15275, 15276, 15277, 15278, 15278.5, 15279, 15280 and 15290, Elections Code.