Cal. Elec. Code § 3403
The envelope into which a new resident is to place the ballot shall bear upon its face the name and official title of the county elections official and upon the other side a printed affidavit in substantially the following form:
State of California County of | } | ss. |
I, ________, declare that I am a citizen of the United States, that on the day of the next election for federal offices shall be at least 18 years of age, a resident of this state prior to the election, and am a resident of the City or Town of ________, County of ________, State of California; I have not voted, nor shall I cast a vote on a ballot from the state from which I have removed. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. | ||
_____ (Date) _____ _____ (Signature) _____ _____ (Residence address) _____ | ||
Ca. Elec. Code § 3403