Ariz. Rev. Stat. § 19-101
Referendum Description
(Insert a description of not more than two hundred words of the
principal provisions of the measure sought to be referred.)
Notice: This is only a description of the measure sought to be referred prepared by the sponsor of the measure. It may not include every provision contained in the measure. Before signing, make sure the title and text of the measure are attached. You have the right to read or examine the title and text before signing.
Petition for Referendum
To the secretary of state (or to the corresponding officer for or on local, county, city or town measures):
We, the undersigned citizens and qualified electors of the state of Arizona, respectfully order that the senate (or house) bill No. _____ (or other local, county, city or town measure) entitled (title of act or ordinance, and if the petition is against less than the whole act or ordinance then set forth here the item, section, or part, of any measure on which the referendum is used), passed by the _________________ session of the legislature of the state of Arizona, at the general (or special, as the case may be) session of said legislature, (or by a county, city or town legislative body) shall be referred to a vote of the qualified electors of the state, (county, city or town) for their approval or rejection at the next regular general election (or county, city or town election) and each for himself says:
I have personally signed this petition with my first and last names. I have not signed any other petition for the same measure. I am a qualified elector of the state of Arizona, county of (or city or town and county of, as the case may be) _____________.
"Warning
It is a class 1 misdemeanor for any person to knowingly sign an initiative or referendum petition with a name other than his own, except in a circumstance where he signs for a person, in the presence of and at the specific request of such person, who is incapable of signing his own name because of physical infirmity, or to knowingly sign his name more than once for the same measure, or to knowingly sign such petition when he is not a qualified elector."
Signature Name Actual Arizona City or Date
(first and address post office town signed
last name (street & address (if any)
printed) no. and if & zip
no street code
address,
describe
residence
location)
(Fifteen lines for signatures which shall be numbered)
The validity of signatures on this sheet must be sworn to by the circulator before a notary public on the form appearing on the back of the sheet.
Number ________________
"It is unlawful to sign this petition before it has a serial number."
"___________ paid circulator" "______________ volunteer".
A.R.S. § 19-101