Utah Code § 20A-7-203
"INITIATIVE PETITION To the Honorable____, Lieutenant Governor:
We, the undersigned citizens of Utah, respectfully demand that the following proposed law be submitted to the legal voters/Legislature of Utah for their/its approval or rejection at the regular general election/session to be held/ beginning on_________(month\day\year);
Each signer says:
I have personally signed this initiative petition or, if I am an individual with a qualifying disability, I have signed this initiative petition by directing the signature gatherer to enter the initials "AV" as my signature:
The date next to my signature correctly reflects the date that I actually signed the initiative petition;
I have personally read the entire statement included with this packet;
I am registered to vote in Utah; and
My residence and post office address are written correctly after my name.
NOTICE TO SIGNERS:
Public hearings to discuss this initiative were held at: (list dates and locations of public hearings.)".
"This initiative seeks to increase the current (insert name of tax) rate by (insert the tax percentage difference) percent, resulting in a(n) (insert the tax percentage increase) percent increase in the current tax rate.".
"This initiative seeks to increase the current (insert name of tax) rate by (insert the tax percentage difference) percent, resulting in a(n) (insert the tax percentage increase) percent increase in the current tax rate."; and
"It is a class A misdemeanor for an individual to sign an initiative petition with a name other than the individual's own name, or to knowingly sign the individual's name more than once for the same initiative petition, or to sign an initiative petition when the individual knows that the individual is not a registered voter.
Birth date or age information is not required, but it may be used to verify your identity with voter registration records. If you choose not to provide it, your signature may not be verified as a valid signature if you change your address before petition signatures are verified or if the information you provide does not match your voter registration records."
Verification of signature collector
State of Utah, County of____
I,_______________, of____, hereby state, under penalty of perjury, that:
I am a resident of Utah and am at least 18 years old;
All the names that appear in this initiative packet were signed by individuals who professed to be the individuals whose names appear in it, and each of the individuals signed the individual's name on it in my presence or, in the case of an individual with a qualifying disability, I have signed this initiative petition on the individual's behalf, at the direction of the individual and in the individual's presence, by entering the initials "AV" as the individual's signature;
I certify that, for each individual whose signature is represented in this initiative packet by the initials "AV":
_______I obtained the individual's voluntary direction or consent to sign the initiative petition on the individual's behalf:
_______I do not believe, or have reason to believe, that the individual lacked the mental capacity to give direction or consent:
_______I do not believe, or have reason to believe, that the individual did not understand the purpose or nature of my signing the initiative petition on the individual's behalf;
_______I did not intentionally or knowingly deceive the individual into directing me to, or consenting for me to, sign the initiative petition on the individual's behalf; and
_______I did not intentionally or knowingly enter false information on the signature sheet;
I did not knowingly make a misrepresentation of fact concerning the law proposed by the initiative;
I believe that each individual's name , post office address, and residence is written correctly, that each signer has read the law proposed by the initiative, and that each signer is registered to vote in Utah ;
The correct date of signature appears next to each individual's name ; and
I have not paid or given anything of value to any individual who signed this initiative packet to encourage that individual to sign it.
_______________________________________________
(Name) (Residence Address) (Date)
Utah Code § 20A-7-203
Amended by Chapter 315, 2011 General Session
Amended by Chapter 315, 2011 General Session, (Coordination Clause)