STATE OF SOUTH )
DAKOTA ) SS
COUNTY OF __________ )
I, the undersigned __________________, being first duly sworn, depose and say, that I am the circulator of the foregoing petition containing ________ signatures; that each person whose name appears on said petition sheet personally signed said petition in my presence; that I believe that each of said signers is a resident at the address written opposite his name; and that I stated to every petitioner before he affixed his signature the legal effect and nature of said petition.
__________________________________
Circulator
Subscribed and sworn to before me this ________________ day of _________________, 19____.
__________________________________
Notary Public
Source: SL 1984 (SS), ch 1, § 25.