"State of Utah, County of ____
I, ______________, declare my candidacy for the office of ____, seeking the nomination of the ____ party. I do solemnly swear, under penalty of perjury, that: I will meet the qualifications to hold the office, both legally and constitutionally, if selected; I reside at _____________ in the City or Town of ____, Utah, Zip Code ____ Phone No. ____; I will not knowingly violate any law governing campaigns and elections; if filing via a designated agent, I will be out of the state of Utah during the entire candidate filing period; I will file all campaign financial disclosure reports as required by law; and I understand that failure to do so will result in my disqualification as a candidate for this office and removal of my name from the ballot. The mailing address that I designate for receiving official election notices is ___________________________.
____________________________________________________________________
Subscribed and sworn before me this __________(month\day\year).
Notary Public (or other officer qualified to administer oath)."; and
"Affidavit of Impecuniosity
Individual Name ____________________________Address_____________________________
Phone Number _________________
I,__________________________(name), do solemnly [swear] [affirm], under penalty of law for false statements, that, owing to my poverty, I am unable to pay the filing fee required by law.
Date ______________ Signature________________________________________________ Affiant
Subscribed and sworn to before me on ___________ (month\day\year)
______________________
(signature)
Name and Title of Officer Authorized to Administer Oath ______________________".
"Filing a false statement is a criminal offense. In accordance with Section 20A-1-609, a candidate who is found guilty of filing a false statement, in addition to being subject to criminal penalties, will be removed from the ballot."
Utah Code § 20A-9-201
Amended by Chapter 208, 2011 General Session