PETITION FOR FORMATION OF A POLITICAL PARTY
I know the contents of this petition including the names of the provisional party officers and request that the ________ party be printed on the ballot for the next general election. I am a registered elector for the next primary and general election. (This statement shall appear at the head of each petition page.)
PROVISIONAL PARTY OFFICERS | ||||
NAME | ADDRESS | |||
CHAIRPERSON __________________________________________ | ||||
TREASURER ____________________________________________ | ||||
PETITIONERS | ||||
(Signature) | (Printed Name) | |||
(Residence) | (Date) | |||
1. ___________________________________________________ | ||||
2. ___________________________________________________ | ||||
VERIFICATION BY CIRCULATORS |
I, ...., do hereby certify that I am a circulator of this petition, and I solely and personally circulated this petition, that all the signatures appearing herein were made in my presence from .... (month) .... (day), .... (year) through .... (month) .... (day), .... (year), and to the best of my knowledge and belief such signatures are those of the persons whose names they purport to be.
.... (signature)
.... (residence address)
W.S. 22-4-402