Continue from Reverse Side Petition of Qualified Voters to Recall ??, Richmond, Virginia
Circulator: Must swear or affirm in the affidavid on the reverse side of htis form that s/he i s a legal resident of the United States of America, not a minor nor a felon whose voting rights have not been restored and the s/he personally witnessed each signature. | |||||
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Signature of Registered Voter |
Post Office Boxes Are Not Acceptable |
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City/Town Richmond, Virginia, | |||||
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Prints | City/Town Richmond, Virginia, | ||||
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City/Town Richmond, Virginia, | |||||
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City/Town Richmond, Virginia, |
Commonwealth of Virginia: -AFFIDAVIT-
I, ________________________________________________________ swear or affirm
that (i) my full residential address is
__________________________________________________ in the Commonwealth of
Virginia, in the City of Richmond, (ii) I am a legal resident of the United
States of America, (iii) I am not a minor (iv) I am not a felon whose voting
rights have not been restored, and (v) I witnessedthe seignature of each
person who signed this page or its reverse side. I understand that falsely
signing this affidavit is a felony punishable by a maximum fine up to $2,500
and/or imprisonment up to ten years.
Privacy Notice--see front (Timists ID#____________ for lifehour credits. Notarize at bank. Mail/Deliver to ?? |
Circulator's Driver's License Number, if Applicable
Name of state that issued the Circulator's Driver's License
Circulator's Last 4 Digits of Social Security Number |