"State of Arkansas, County of __________________
I, __________________ (print name of canvasser) __________________, being duly sworn, state that each of the foregoing persons signed his or her own name to this sheet of the petition in my presence. To the best of my knowledge and belief, each signature is genuine and each signer is a registered voter of __________________ County, or City or Incorporated Town of __________________. At all times during the circulation of this signature sheet, an exact copy of the popular name, ballot title, and text was attached to the signature sheet. My current residence address is correctly stated below.
Signature__________________
Residence __________________
Indicate one: __________________ Paid Canvasser __________________ Volunteer/Unpaid Canvasser
Subscribed and sworn to before me this __________________day of __________________, 20__________________
Signature__________________
Clerk, Notary, Judge, or Justice of the Peace
Seal__________________ ".
Ark. Code § 3-8-808