(b) Have attached to it, when filed, an affidavit signed by the person who circulated the document in substantially the following form:STATE OF NEVADA
COUNTY OF _______________
I, ___________________ (print name), being first duly sworn under penalty of perjury, depose and say:
(1) that I reside at ______________ (print street, city and state); (2) that I am 18 years of age or older; (3) that I personally circulated this document; (4) that all signatures were affixed in my presence; (5) that the number of signatures affixed thereon is ___________________; and (6) that each person who signed had an opportunity before signing to read the full text of the act or resolution on which the initiative or referendum is demanded.______________________
Signature of circulator
Subscribed and sworn to or affirmed
before me this____ day of _____,_____.
______________________________________
Notary public or other person licensed
to administer an oath