Fillable STATE OF ARIZONA Application for Seri al Number (Arizona Secretary of State)

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STATE OF ARIZONA Application for Seri al Number (Arizona Secretary of State)

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Office of the Secretary of State
1700 W. Washington Street
Phoenix, Arizona 85007
Rev. 01/15/2021
STATE OF ARIZONA
Application for Seri
al Number
Recall Petition
A.R.S. § 19-202.01
The undersigned intends to circulate and file a
recall petition demanding the recall of:
(Name)
(Title of Office Held)
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.
Date of Application
Signatures Required
Deadline for Filing
Serial Number Issued
The grounds of the recall are as follows:
Name of Applicant
Committee Name (if applicable)
Address
Committee ID No. (if applicable)
City
State Zip Chairperson (if applicable)
Telephone Number
Treasurer (if applicable)
E
-mail Address
Committee Address (if applicable)
City State Zip
Committee Telephone Number (if applicable)
Committee E-mail Address (if applicable)
By submitting this Application for Serial Number and checking all boxes below, I acknowledge the following:
That I have read and understand the accompanying Instructions for Statewide Recall, including the
Secretary of State's recommended best practices for printing copies of the Statewide Recall
Petition to be circulated.
That at the time of filing, I was provided instructions regarding accurate completion of the electronic
Statewide Recall Petition form.
FOR OFFICE USE ONLY
Applicant Signature
Date
Enter a general statement of not more than 200 words stating the grounds of the demand for the recall.
Office of the Secretary of State
1700 W. Washington Street
Phoenix, Arizona 85007
Rev. 01/15/2021
Instructions for Statewide Recall
Application for Serial Number and Best Practices for
Printing and Circulating Petitions
Statement of Organization
A recall measure can be sponsored by an individual or a committee. If a committee is serving as the applicant, it
must file a Statement of Organization using the Secretary of State’s Campaign Finance Filing System at or before
the time of submitting an Application for Serial Number. The Secretary of State will not accept an Application
from a committee without an accompanying statement or designation.
Application for Serial Number
All individuals or organizations wishing to recall a state officer must submit an Application for Serial Number
stating their intent to circulate a statewide recall petition.
To complete the PDF application, please enter all required fields including:
•
The name and title of the officer to be recalled.
•
A general statement of not more than two hundred words stating the grounds of the demand for the
recall, which will be printed on the face of each petition sheet.
•
All information required to identify the recall applicant and sponsoring committee (if applicable).
Application Procedure
Upon receipt of the 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 Recall 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.
•
The minimum number of signatures required to recall a public officer is equal to 25% of the number of
votes cast at the last preceding general election for all the candidates for that office, even if the officer
was not elected at that election, divided by the number of offices that were being filled at that election.
•
The deadline to file recall petition signatures is no later than 120 days after the date of submission of the
Application for Serial Number.
•
Any revision to the 200-word general statement requires a new Application for Serial Number to be filed,
and all previous versions will be considered invalid.
Office of the Secretary of State
1700 W. Washington Street
Phoenix, Arizona 85007
Rev. 01/15/2021
Recommended Best Practices for Printing and Circulating Petitions
The Statewide Recall Petition form has been updated and redesigned to be compatible with 21st century
signature verification technology and 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:
Petitions must be printed at a resolution of 600dpi or higher. The boxed fields on the petition serve to identify
where petitioners and circulators should enter applicable information. It is critical that petitions be printed at
600dpi or higher to keep these boxes intact.
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 signatures and identifying information are 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 should ensure they print their Circulator ID Number on the front and back side of
each petition sheet. Failure to use the 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.
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STATE OF ARIZONA Application for Seri al Number (Arizona Secretary of State)

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Completed 27 January 2021

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