The undersigned, qualified electors of __________ county, state of Arizona, do hereby nominate __________, who resides at __________ in the county of __________, as a candidate for the office of _______ at the general (or special, as the case may be) election to be held on the ________ day of _________, _____.
I hereby declare that I have not signed the nomination petitions of any candidate for the office to be voted for at this primary election, and I do hereby select the following designation under which name the said candidate shall be placed on the official ballot (here insert such designation not exceeding three words in length as the signers may select).
A.R.S. § 16-341