You signed a petition for the following initiative:
[insert title of initiative]
To access a copy of the initiative petition, the initiative, the fiscal impact statement, and information on the deadline for removing your signature from the petition, please visit the following link: [insert a uniform resource locator that takes the individual directly to the page on the lieutenant governor's or county clerk's website that includes the information referred to in the email].
"Verification of initiative sponsor State of Utah, County of __________ I, __________, of __________, hereby state, under penalty of perjury, that:
I am a sponsor of the initiative petition entitled ____________________ ; and
I sent, or caused to be sent, to each individual who provided a legible, valid email address on a signature sheet submitted to the county clerk in relation to the initiative petition, the email described in Utah Code Subsection 20A-7-105(5)(c).
______________________________________________________________ __
(Name) (Residence Address) (Date)".
Utah Code § 20A-7-105