"I, (print name) ____________, being first duly sworn, say that I reside at (Street) ____________, City of ________________, County of ________________, state of Utah, (Zip Code) ______, (Telephone Number, if any)____________; that I meet the qualifications for the office of board of trustees member for _______________________ (state the name of the special district); that I am a candidate for that office to be voted upon at the next election; and that, if filing via a designated agent, I will be out of the state of Utah during the entire candidate filing period, and I hereby request that my name be printed upon the official ballot for that election.
(Signed) _________________________________________
Subscribed and sworn to (or affirmed) before me by ____________ on this ______ day of ____________, ____.
(Signed) ________________________
(Clerk or Notary Public)".
Utah Code § 17B-1-306