At least 68 days before a presidential primary, the Secretary of State shall transmit to each elections official a certified list containing the names and addresses of the candidates for delegates for whom nomination papers have been filed and who are entitled to be voted for at the presidential primary.

The certified list shall be in substantially the following form:

Certified List of Candidates for Delegate
Secretary of State

To the Elections Official of ____ County:

I, ____, Secretary of State, do hereby certify that the following list contains the name and post office address of each person for whom nomination papers have been filed in my office and who is entitled to be voted for at the presidential primary to be held on the ____ day of ____, 20__, as delegate to the next national convention of the American Independent Party; I further certify that in the list, under the name of the person for whom a preference as nominee of the American Independent Party for President has been expressed, or under the name of the chairman of a group not expressing a preference, there is stated the name of each candidate for delegate who has filed a statement pursuant to Section 6567, and who may be voted for as one of a group.

LIST OF CANDIDATES American Independent Party __________
Candidates preferring __________		Candidates preferring __________		No preference (Name of chairman) __________
__________
Name Address Top of group		Name Address Top of group		Name Address Top of group
1.__________		1.__________		1.__________
2.__________		2.__________		2.__________
3.__________		3.__________		3.__________
etc.		etc.		etc.
Dated at Sacramento, California, this ______ day of ______, 20___.
		__________
(SEAL)		(Secretary of State)