AFFIDAVIT OF CIRCULATOR AND PETITION CHAIRPERSON
State of Georgia
County of __________________
Under the penalty of a violation of Code Section 16-10-71 of the Official Code of Georgia Annotated, relating to false swearing, punishable by a fine not to exceed $1,000.00 or by imprisonment of not less than one nor more than five years, or both, we the undersigned do depose and say that each person sponsoring or signing the recall application of __________________ is an elector of the electoral district of the officer sought to be recalled and further depose and say that the fact or facts upon which the ground or grounds for recall are based are true.
__________________
(Signature of circulator)
__________________
(Residence address)
(Number and street or route)
__________________
(City)
__________________
(Signature of petition chairperson)
__________________
(Residence address)
(Number and street or route)
__________________
(City)
Subscribed and sworn to
before me this __________________
day of __________________, __________________.
Notary public
__________________
__________________, Georgia
My commission expires on the __________________ day of __________________, __________________.
No notary public may sign the application as an elector or serve as a circulator of any application which he or she notarized. Any and all sheets of an application for a recall petition that have the circulator's affidavit notarized by a notary public who also served as a circulator of one or more sheets of the application for a recall petition or who signed one of the sheets of the petition as an elector shall be disqualified and rejected.
OCGA § 21-4-5