ATTACHMENT 1
City of Imperial Beach
Mayor Vacancy Application Form
Mayor of The City of Imperial Beach – Appointment Application Vacant Seat for At-Large Position
Term Ending: After the election in November of 2026
�Applicant Information
Field Response
Full Legal Name
Residential Address
Mailing Address (if different)
Phone Number
Email Address
Are you a registered voter in Imperial
Beach?
☐ Yes ☐ No
ATTACHMENT 1
�Eligibility and Background
1. Do you meet all eligibility requirements to serve as Mayor as defined by the State Law? ☐ Yes ☐ No (If no, explain below)
2. Please list any boards, commissions, or public service roles you’ve held:
[List experience]
�Statement of Interest
1. Why are you interested in serving as Mayor? (Attach additional sheets if necessary)
2. What are your top priorities or goals for the city if appointed?
3. What experience, education, or skills do you bring to the role?
ATTACHMENT 1
�Conflict of Interest Disclosure
Please disclose any business, organizational, or financial affiliations that could pose a conflict of interest with city matters below:
�Signature & Certification
By signing below, I certify that:
• I am eligible to serve as Mayor of the City of Imperial Beach under applicable laws. • The information provided is accurate and complete.
• I understand that this application and related materials may be public record. • I understand that the appointment process will be public and may include interviews, council deliberation, and public comment.
Signature: __________________________________________ Date: __________________ Attachments Required
• Resume (optional)
• Any supplemental materials (letters of support, etc.) • Application to View Voter Registration Information (required) (attached) Submission Instructions
• Submit by: 5:00 p.m. on August 27, 2025
• Submit to: [email protected]
• Questions? Contact: Jacqueline Kelly - 619-423-8616 - [email protected]
2024 Municipal Elections Handbook For CA City/ Town Clerks Forms
APPLICATION TO VIEW
VOTER REGISTRATION INFORMATION
"State law prohibits the use of voter registration information for commercial purposes." This agreement is between the following applicant and the City Clerk for the purpose of obtaining access to voter registration information pursuant to California Elections Code§ 2188.
Please PRINT or TYPE necessary information.
Applicant's Name (in full):
Residence Address:
City: State, Zip: Telephone:
Business Address:
City: State, Zip: Telephone:
Complete the following if information is requested on behalf of an organization or individual other than applicant.
Organization/Individual Name:
Address:
City: State, Zip: Telephone:
Name of Individual Authorizing Applicant:
The specific information requested is stated below:
Registration information will be used for the purpose stated below:
I certify under penalty of perjury under the laws of the State of California that information on this application is true and correct.
Executed on (Date) at (Location)
Signature of Applicant: Driver's License No.:
The elections official shall request the applicant to display his or her identification for purposes of verifying that the identifying numbers of the identification document match those written by the applicant on the application form. (§ 2188, Elections Code.)
e Use Only: Reviewed By: __________________ Date: ____ _ §§2188, 18109, E.C., 7924.000, G.C
(Revise 10/2015)
Application to View Voter Registration Information
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Forms
Name, Date of Birth, and Residence Address
Verification of voter registration within the City of Imperial Beach for filling the vacancy in the office of the Mayor.
Contact the ROV to verify voter registration. Page 205 of 205