STATE OF VIRGINIA COUNTY OF I, the undersigned, Ben Carson, having previously filed a Certificate with the New York State Board of Elections to have my name placed on the New York State Presidential Primary Election ballot for the Republican Primary Election to be held on April 19, 2016, and having been certified as such candidate by the New York State Board of Elections by certificate dated March 23, 2016, And the New York State Election providing an opportunity for me to file a Certificate with the New York State Board of Elections pursuant to the provisions of the Election Law at section 2-122-b(3)(d) no later than the day before the April 19, 2016 allowing that a “presidential candidate[s] may file a certificate with the state board of elections deeming any vote for such CERTIFICATE OF DECLINATION OF PRESIDENTIAL CANDIDATE. PURSUANT TO ELECTION LAW SECTION 2-122-b(3)(d) presidential candidate to be a void vote”, NOW THEREFORE, the undersigned presidential candidate, Ben Carson, des here) file this Certificate of Declination to have my name appear on the presidential ballot for any purpose other than to provide that any vote cast for me at the April 19,2016 Republican = Presidential Primary Election be deemed a void vote as allowed and provided for in seetion:2- 122-b(3)(d) of the Election Law provided that this Certificate is filed for such purp\ than the day before such primary election, to wit: April 18, 2016. WHEREFORE, the undersigned, Ben Carson, has placed his signature heréto as alfiived q3tia under the above stated provisions of the New York Election Law to certify that any votes cast for him in the April 19, 2016 Presidential Republican Primary Election be deemed to be void votes. onthe _ /6*” day of April, 2016 before me personally appeared Ben Carson to me known and known to me to be the person who is described in the above Certificate and who executed the same instrument in my presence and he acknowledged to me the he executed this Certificate. BEN CARSONCERTIFICATE OF DECLINATION OF PRESIDENTIAL CANDIDATE PURSUANT TO ELECTION LAW SECTION 2-122-b(3)(d) STATE OF ret Aerie, (3 counTY oF (2... eae Hy I, the undersigned, Ben Carson, having previously filed a Certificate with the New York State Board of Elections to have my name placed on the New York State Presidential Primary Election ballot for the Republican Primary Election to be held on April 19, 2016, and having been certified as such candidate by the New York State Board of Elections by certificate dated March 23, 2016, And the New York State Election providing an opportunity for me to file a Certificate with the New York State Board of Elections pursuant to the provisions of the Election Law at section 2-122-b(3)(d) no later than the day before the April 19, 2016 allowing that a “presidential candidates] may file a certificate withthe state board of elections deeming any ote fr yeh presidential candidate to be a void vote”, o- NOW THEREFORE, the undersigned presidential candidate, Ben Carson, does fieby a file this Certificate of Declination to have my name appear on the presidential ballot for any purpose other than to provide that any vote cast for me at the April 19, 2016 Republican -g Presidential Primary Election be deemed a void vote as allowed and provided for inysection 2- 122-b(X4) ofthe Election Law provided that this Certificate is fied for such purpose ae] than the day before such primary election, to wit: April 18, 2016. WHEREFORE, the undersigned, Ben Carson, has placed his signature hereto as allowed under the above stated provisions of the New York Election Law to certify that any votes cast for him in the April 19, 2016 Presidential Republican Primary Election be deemed to be void votes. BEN CARSON onthe 5% day of April, 2016 before me personally appeared Ben Carson to me known and known to me to be the person who is described in the above Certificate and who ‘executed the same instrument in my presence and he acknowledged to me the he executed this, Certificate. A Rrra Top senroameatrete weet Fo Bre 010CERTIFICATE OF DECLINATION (Section 6-146, Election Law) , fos amin Cannan Sr | residing at ‘(Candidate's Name) 992 Eqref Poente Lane Wert Helm Penk P3502. caaaressy having been designated/nominated by the Keyphhicar (Name of Party) Party, as a candidate for the office of exolen? ot tha Luited Serer (Title of Office and Poltcal Subdivision) distict, ata Fema (District Number if any) (SpecidPrimaryiGeneral) election to be held on Ape 10% 20 Le do hereby DECLINE such designation/nomination. Aye (5) 20lt i i, — Datey (Gianature of Candidatey S 3 on State of New York sz County of ss: z 5 Nw ) ga Onthis 16 y of Agi! —_, 201k Sbeforetfe itn sda. | to me known and known to me to be personally appeared Cosy the individual described therei acknowledged to me that he/she executed the same. and who executed the foregoing instrument, and (Sample Prepared by State Board of Elections) Rev 042012CERTIFICATE OF DECLINATION OF PRESIDENTIAL CANDIDATE PURSUANT TO ELECTION LAW SECTION 2-122-b(3)(d) STATE OF VIRGINIA ssi: COUNTY OF 1, the undersigned, Ben Carson, having previously filed a Certificate with the New York State Board of Elections to have my name placed on the New York State Presidential Primgry Election ballot for the Republican Primary Election to be held on April 19, 2016, ane’havine been certified as such candidate by the New York State Board of Elections by cet March 23, 2016, And the New York State Election providing an opportunity for me to file Gertiioge with the New York State Board of Elections pursuant to the provisions of the Electitin Lawat section 2-122-b(3)(d) no later than the day before the April 19, 2016 allowing that "presigential candidate[s] may file a certificate with the state board of elections deeming any ve for seh. presidential candidate to be a void vote”, NOW THEREFORE, the undersigned presidential candidate, Ben Carson, docs hereby file this Certificate of Declination to have my name appear on the presidential ballot for any purpose other than to provide that any vote cast for me at the April 19, 2016 Republican Presidential Primary Election be deemed a void vote as allowed and provided for in section 2- 122-b(3)(d) of the Election Law provided that this Certificate is filed for such purpose no later than the day before such primary election, to wit: April 18, 2016. WHEREFORE, the undersigned, Ben Carson, has placed his signature hereto as allowed under the above stated provisions of the New York Election Law to certify that any votes cast for him in the April 19, 2016 Presidential Republican Primary Election be deemed to be void votes. ee BEN CARSON On the day of April, 2016 before me personally appeared Ben Carson to me known and known fo me to be the person who is described in the above Certificate and who executed the same instrument in my presence and he acknowledged to me the he executed this Certificate.CERTIFICATE OF DECLINATION (Section 6-146, Election Law) Benjamin S$ Gerson Sr residing at (Candidate's Name) 10942 Egret Parte Lance, west Calm tench FL 3302 (Address) Re publican (Name of Party) Party, as a candidate for the office of [resident of the United States (Tile of Office and Political Subdivision) having been designatedinominated by the district, at a frinery ‘Dist Number any) ‘GpecidvPrimanyiGenora a election to be held on April /7™ 12016, do hereby DECLINE such designation/nomination. orl 16, 20/e Liz f.—— Date) (Gignatufe of Candidate) — stato of New var Steet! personally appeared = the individual described therein, and who executed the foregoing instrumenfard acknowledged to me that he/she executed the same. County of £20rc Wee + ss = Mh ss = 2 On this _15 120. bafore me on m to me known and known to@fto by a a (Sample Prepared by State Board of Elections) Rev o2012