Revised 5/16/2019 Secretary of State
Petitioner/circulator remains solely responsible for ensuring this form complies with Arizona law.
I, a person who is not required to be a resident of this state but who is otherwise
(Printed Name)
qualified to register to vote in the county of , in the state of Arizona, hereby verify that each of the names on the
petition was signed in my presence on the date indicated; that in my belief each signer was a qualified elector who resides at the address given as their
residence on the date indicated.
Signature of Circulator
Typed or Printed Name of Circulator
Circulator’s Actual Residence Address
(If no street address, a description of residence location shall be included on
the petition)
City or Town and Zip Code
Instructions for Circulators
1.
All petitions shall be signed bycirculator.
2.
Circulator is not required to be a resident of this state but otherwise must be qualified to register to vote in this state and, if not a resident of this
state, shall register as a circulator with the secretary of state.
3.
Circulator’s name shall be typed or printed under the circulator’s signature.
4.
Circulator’s actual residence address or, if no street address, a description of residence location shall be included on the petition.