STATE OF ARIZONA
Application for Se
rial Number
Referendum Petition
A.R.S. § 19-111
FOR OFFICE USE ONLY
The undersigned intends to circulate and file a referendum
petition and hereby makes application for the issuance of an
official serial number to be printed in the lower right-hand
corner of each side of each signature sheet of such petition.
Attached hereto is the full title and text, in no less than
eight point type, of the measure intended to be referred
at the next general election.
Measure to be Referred
Date of Application
Signatures Required
Deadline for Filing
Serial Number Issued
By submitting this Application for Serial Number and checking all boxes below, I acknowledge the following:
That I have r
eceived and will review the accompanying Instructions for Statewide Referenda,
including the Secretary of State's recommended best practices for printing copies of the Statewide
Referendum Petition to be circulated.
That at the time of filing, I was provided instruc
tions regarding accurate completion of the Statewide
Referendum Petition form.
Applicant Signature Date
Name of Applicant
Committee Name
Address Committee ID No.
City State Zip
Chairperson
Telephone Number Treasurer
E-mail Address
Committee Address
City
State Zip
Committee Telephone Number
Committee E-mail Address
Office of the Secretary of State
1700 W. Washington Street
Phoenix, Arizona 85007
Rev. 03/04/2019
Enter a description of no more than one hundred words of the principal
provisions of the proposed measure that will appear in no less than
eight point type on the face of each petition signature sheet to be circulated.
click to sign
signature
click to edit
Office of the Secretary of State
1700 W. Washington Street
Phoenix, Arizona 85007
Rev. 03/04/2019
Instructions for Statewide Referenda
Application for Serial Number and Best Practices for
Printing and Circulating Petitions
Statement of Organization
At the time of submitting an Application for Serial Number, the individual or organization wishing to refer a
measure to the ballot must either file a Statement of Organization using the Secretary of State’s Campaign Finance
Filing System or designate an existing (non-candidate) committee to act as the referendum’s sponsor. The
Secretary of State will not accept an Application without an accompanying statement or designation.
Application for Serial Number
All individuals or organizations wishing to refer a measure to the ballot must submit an Application for Serial
Number stating their intent to circulate a statewide referendum petition.
To complete the PDF application, please enter all required fields including:
The bill number to be referred (e.g. H.B. ####);
A no more than 100-word description of the principal provisions of the measure to be referred, which will
be printed on the front of each petition sheet; and
All information required to identify the referendum applicant and sponsoring committee.
Application Procedure
Upon receipt of an Application, the Secretary of State will complete the remainder of the form and issue a unique
serial number to be printed on the front and back of each petition sheet. The Secretary of State will also provide
instructions regarding proper completion of the Statewide Referendum Petition form.
Please note:
An Application for Serial Number will not be accepted unless the applicant has checked both disclaimer
boxes and provided a signature as an acknowledgment of the required printing and circulating
procedures.
At the time of submission, an Application for Serial Number must include the accompanying title and text
of the measure to be referred.
The minimum number of signatures required to refer a measure to the ballot is equal to 5% of the
number of votes cast at the last gubernatorial election.
The deadline to file referendum petition signatures is no later than 90 days after sine die (the date of
adjournment of the legislative session in which the measure was passed).
Any revision to the title and text or 100-word description requires a new Application for Serial Number to
be filed. All previous versions and signatures collected will be considered invalid.
Office of the Secretary of State
1700 W. Washington Street
Phoenix, Arizona 85007
Rev. 03/04/2019
Recommended Best Practices for Printing and Circulating Petitions
The Statewide Referendum Petition form is designed to be compatible with electronic petition review technology
and verification procedures. The Secretary of State’s Office recommends the following best practices for printing
and circulating petitions to ensure optimal verification and processing. Failure to adhere to these practices may
result in reduced document integrity, which may inhibit the Secretary of State’s ability to efficiently and accurately
process the petitions.
1.
Print Resolution of 600dpi or Higher:
The Secretary of State's Office recommends that petitions be printed at a resolution of 600dpi or higher to
preserve print integrity and assist in the digital scanning and review process. This will ensure that the form field
lines on the petition remain intact, and that information provided by the committee (such as the initiative
description and petition serial number) is clearly printed for inspection by petitioners.
2.
Print from Digital File Only Do Not Photocopy
It is recommended that petitions be duplicated only by means of digital printing and should not be photocopied.
Photocopied petitions may result in a degraded image, including the loss of information capture boxes, pixelated
text or irregularities that may obstruct scanning capability. To avoid document degradation, please print petitions
from a digital file only.
3.
Instructions to Signers
Circulators should instruct petition signers to write in the center of (and within) the information capture boxes to
ensure that signature and identifying information is easily discernable by the petition processing software. Signers
should avoid letting information bleed over to adjacent rows, and should sign with blue or black ink.
4.
Circulator ID Number
Paid and out-of-state circulators are strongly encouraged to print their Registered Circulator ID Number on the
front and back side of each petition sheet. Failure to include the Registered Circulator ID Number will not (by itself)
invalidate the petition sheet, but greatly inhibits the Secretary of State’s ability to efficiently and accurately
process the petition.