13-28-203. Affidavit to accompany signatures. An affidavit, in substantially the form provided in 1-6-105 or in the following form, must be attached to each petition sheet or petition section submitted to the county official:

I, (name of person who is the signature gatherer), swear that I gathered the signatures on the petition to which this affidavit is attached on the stated dates, that I believe the signatures on the petition are genuine, are the signatures of the person whose names they purport to be, and are the signatures of [insert appropriate local government unit] electors who are registered at the address or have the telephone number following the person's signature, and that the signers knew the contents of the petition before signing the petition.

________________________________

(Date on which the first signature was gathered)

________________________________

(Signature of petition signature gatherer)

________________________________

(Address of petition signature gatherer)

Subscribed and sworn to me this ___ day of ____, 20__

Seal

_______________________________

(Person authorized to take oaths)

_______________________________

(Title or notarial information)