STATE STATUTES & CODES
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MISSOURI STATUTES AND CODES
321.495. Form of petition.
321.495. 1. A petition for a referendum shall be in substantially thefollowing form:
WARNING
It is a felony for anyone to sign any initiative or referendum petitionwith any name other than his own, or to knowingly sign his name more than oncefor the measure, or to sign such petition when he is not a legal voter.
INITIATIVE PETITION To the board of directors of the...... Fire Protection District:
We the undersigned, citizens and voters of the state of Missouri and the........... Fire Protection District, respectfully order that (describe themeasure) shall be referred to the people of the district for their approval orrejection, at the regular (special) election to be held on the ..... day of...., 20.., and each for himself says: I have personally signed thispetition; I am a duly qualified elector of the state and district; myresidence and post-office address are correctly written after my name. Name...... Residence ...... Post Office ......
(if in a city, street and number)
(Here follow numbered lines for signatures.)
2. Every sheet for petitioners' signatures shall be attached to a fulland correct copy of the title and text of the measure proposed by theinitiative petition. Referendum petitions shall be attached to a full andcorrect copy of the measure on which the referendum is demanded.
3. Each sheet of every petition containing signatures shall be verifiedin substantially the following form by the person who circulated the sheet, byhis affidavit thereon: State of Missouri County of .....
I,....., being first duly sworn, say that each person whose name appearson this sheet signed his name thereto in my presence; I believe that each hasstated his name, post-office address and residence correctly, and that eachsigner is a voter of the state of Missouri and ......... Fire ProtectionDistrict.
(signature and post-office address of affiant)
Subscribed and sworn to before me this .... day of ...., 20...
(signature and title of officer before whom oath is made and hispost-office address)
(L. 1969 H.B. 322, A.L. 1978 H.B. 971)