Affidavit for Primary Ballot Name Change Request
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Document Overview
This is a legal form issued by the County of Blair Board of Elections in Hollidaysburg, Pennsylvania. It is designed for a candidate running in the 2025 Primary Election who wishes to have their name printed on the ballot under a specific name they are widely known by, rather than their legal name.
Purpose and Requirements
The form allows a candidate to request that their preferred name be used on the ballot based on the following criteria:
- The candidate has continuously and routinely transacted business and social affairs under the requested name.
- The candidate is widely known in the community and by the electorate under that name.
- Refusing to use this name would confuse voters and diminish their right to vote for the candidate of their choice.
Key Information Required
To complete this affidavit, the following details must be provided:
- Candidate Identification: Full legal name and the specific office and district for which they are running.
- Requested Name: The name to be printed on the ballot (to be printed clearly).
- Sworn Statement: The document must be sworn to and subscribed before a notary public or other authorized official.
- Candidate Details: The candidate must sign the document and provide their office, district, street address, city, and zip code.
- Official Certification: An authorized official must sign, provide their title, and list the expiration date of their commission.
Contact Information
The form includes contact details for the Blair County Courthouse:
- Address: 279 Loop Rd, Hollidaysburg, PA 16648
- Elections Office: (814) 693-3287
- Voter Registration Office: (814) 693-3150
- Board Members: Laura O. Burke, Amy Webster, David Kessling
- Director: Sarah Seymour