Petition Form

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Petition Form (not revised to include the following):

A Warning Statement should appear on the petition:

It is a class 1 misdemeanor for any person to knowingly sign an initiative or referendum petition with a name other than his own, except in a circumstance where he signs for a person, in the presence of and at the specific request of such person, who is incapable of signing his own name because of physical infirmity, or to knowingly sign his name more than once for the same measure, or to knowingly sign such petition when he is not a qualified elector.

I, [Name of Petition Circulator], certify that each of the above individuals signed his or her name thereto in my presence; I believe that each has stated his or her name and property address correctly, and that each signer is a resident of (named) Community, City of  (named), Arizona, County of  (named).

The Name of the Petition Circulator(s) should be clearly printed so as to be legible. This should be followed on each page by:

1. Signature of the Circulator(s)
2. Date Signed by the Circulator(s)
3. Resident Address of the Circulator(s)