Within three days of receiving the names of delegate candidates from the chairpersons of the steering committees, the Secretary of State shall transmit to each elections official a certified list, for each congressional district wholly or partially within that county, containing the names of the delegate candidates selected and pledged to each candidate or uncommitted delegation who is entitled to be voted for on the ballot at the presidential primary.

The certified list shall be in substantially the following form:

Certified List of Delegate CandidatesIn the ____ Congressional District

To the County Elections Official of ____ County:

I, ____, Secretary of State, do hereby certify that the following persons, listed beneath the name of the presidential candidate or uncommitted delegation they are pledged to, are the delegate candidates who will represent the voters of this congressional district at the ____ Democratic National Convention to the extent, based on his or her proportional share of the total votes for president in this district, that each presidential candidate or uncommitted delegation is entitled to delegates from this district.

List of Delegates Pledged to Presidential Candidates and Uncommitted Delegations In the _____ Congressional District

Delegates Pledged to Rosaly Lever Deborah Seiler Elaine Ginnold George Mann Darren Chesin

Delegates Pledged to Janice Atkinson John Mott-Smith Rosa Garcia-Viteri Bruce Bolinger Mary DeLost

Delegates Pledged to Christopher Zirkle

Delegates Pledged to Unpledged Delegation, James Ashford, Chairperson

Mark Terry Romulo Lopez Linda M. Gonzalez Joe Ayala Lori Joseph

Abra Reynaga Sylvia Cheng Michael Ognisty Bill Pitts Lynne Chinn

Dated at Sacramento, California, this ____ day of ______, 20__.

(seal)

______________ Secretary of State

(Amended by Stats. 2011, Ch. 296, Sec. 82. (AB 1023) Effective January 1, 2012.)