I, a person who is not required to be a resident of this state but who is otherwise 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.
Typed or Printed Name of Circulator
Circulator's Actual Residence Address
(If no street address, a description of residence
included on the petition)
City or Town and Zip Code
Arizona Secretary of State – Revised Jun. 2019
Instructions for Circulators
All petitions shall be signed by circulator.
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.
Circulator’s name shall be typed or printed under the circulator’s signature.
Circulator’s actual residence address or, if no street address, a description of residence location shall be included on the petition.