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INSTRUCTIONS

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calling of an election to recall'

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RECALL PETITION
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and State of Michigan, petition for' for the following reason(s):

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STREET ADDRESS OR RURAL ROUTE ZIP CODE MONTH

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CERTIFICATE OF CIRCULATOR

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The undersigned circulator of the above petition asserts that he or she is a qualified and registered elector of the electoral district of the official whose recall is sought; lhat each signature on the petition was signed in his or her presence and was not obtained through fraud. deceit or misrepresentation; and that he orshe neither caused nor permitted a person to sign the petition more than once and has no knowledge of a person signing the petition more than once. The undersigned circulator of the above petition further asserts that to his or her best knowledge, information and belief each signature is the genuine signature of the person purporting to sign the petition; the person signing the petition was at the time of signing a qualified registered elector of the City

CIRCULATORDO NOT SIGN OR DATE CERTIFICATE UNTIL AFTER CIRCULATING PETITION.

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(SlgIlature of Circulator) (Date)

(Printed Name. of CirCUlator)

or Township listed in the heading ollhe petition; arid the elector was qualified to sign the petition.

WARNING-A CIRCULATOR KNOWINGLY MAKING A FALSE STATEMENT IN THE ABOVE CERTIFICATE,A PERSONNOTA CIRCULATORWHOSIGNSAS A CIRCULATOR,ORA PERSONWHO SIGNS A NAME OTHERTHAN HIS OR HEROWNAS CIRCULATORIS GUlLTV OF A MISDEMEANOR.
Michigan Election Resources - Form No. 2011 . .2002 Revision - Approved by State Oirector of Elections

(City or TOW,nship Where Registered)

Complete Residence Address (Street and Number or Rural Route)

(ZIp Code)

INSTRUCTIONS
We. the

ON REVERSE

SIDE

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undersigned. registered and qualified voters of theTownship of

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RECALL PETITION
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WARNING-A PROVISIONS

PERSON WHO KNOWINGLY SIGNS A RECALL OF THE MICHIGAN ELECTION LAW

PRINTED NAME

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SIGNATURE

DATE OF SIGNING MONTH DAY YEAR

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CERTIFICATE

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The undersigned circulator of the above petition asserts that he or she is a qualified and registered elector of the electoral district of the official whose recall is sought; that each signature on the petition was signed in his or her presence and was not obtained through fraud. deceit or misrepresentation; and that he or she neither caused nor permitted a person to sign the petition more than once and has no knowledge of a person signing the petition more than once. The undersigned circulator of the above petition further asserts that to his or her best knowledge. information and belief each signature is the genuine signature of the person purporting to sign the petition; the person signing the petition was at the time of signing a qualified registered elector of the City or TOlNT1Ship listed in the heading of the petition; arid the elector was qualified to sign the petition.

CIRCULATOR - DO NOT SIGN OR DATE CERTIFICATE UNTIL AFTER CIRCULATING PETITION.

I
(Signature of Circulator) (Date)

(Printed Name. of Circulator)

WARNING-A CIRCULATOR KNOWINGLY MAKING A FALSE STATEMENT IN THE ABOVE CERTIFICATE,A PERSONNOTA CIRCULATORWHOSIGNSAS A CIRCULATOR,ORA PERSONWHO SIGNSA NAME OTHERTHAN HIS OR HER OWN AS CIRCULATORIS GUlLTV OF A MISDEMEANOR.
Michigan

(City or TOW_hShlpWhete Registered)

Complete Residence Address

(Street and Number or Rural Route)

(ZIp Code)

Election

Resources

Form No. 2011 . 2002 Revision

Approved

by State Director

of Sections

INSTRUCTIONS

ON REVERSE

SIDE

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We, the undersigned, registered and qualified voters of theTownship of }

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RECALL PETITION
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PROVISIONS - --

PERSON WHO KNOWINGLY SIGNS A RECALL OF THE MICHIGAN ELECTION LAW

PRINTED NAME

PETITION

MORE THAN ONCE OR SIGNS A NAME OTHER THAN

HIS OR HER OWN IS VIOLATING

MONTH

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1. 2. 3. 4. 5. 6. 7. 8. g. 10. 11. 12.

SIGNATURE

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The undersigned circulator of the above petition asserts that he or she is a qualified and registered elector of the electoral district of the official whose recall is sought; that each signature on the petition was signed in his or her presence and was not obtained through fraud, deceit or misrepresenlation; and that he or she neither caused nor permitted a person to sign the petition more than once and has no knowledge of a person signing the petition more than once. The undersigned circulator of the above petition further asserts that to his or her best knowledge, information and belief each signature is the genuine signature of the person purporting to sign the petition; the person signing the petition was at the time of signing a qualified registered elector of the City or iownship listed in the heading of the petition; arid the elector was qualified to sign the petition.

CIRCULATOR - DO NOT SIGN OR DATE CERTIFICATE UNTIL AFTER CIRCULATING PETITION.

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(Signature of Circulator) (Date)

(Printed Name. of Circ';'lator)

WARNING-A CIRCULATOR KNOWINGLY MAKING A FALSE STATEMENT IN THE ABOVE CERTIFICATE,A PERSONNOTA CIRCULATORWHO SIGNSAS A CIRCULATOR,ORA PERSONWHO SIGNS A NAME OTHERTHANHISOR HEROWN AS CIRCULATORIS GUlLTV OF A MISDEMEANOR.
MicIig:an Electbn Besources - Fonn No. 2011 - 2002 Revision - Approved by State Director of Elections

(City or Tow!'ship Where Registered)

Complete Residence Address (Street and Number or Rural Route)

(Zip Code)

RECALL PETITION
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WARNING-A PROVISIONS

PERSON WHO KNOWINGLY SIGNS A RECALL OF THE MICHIGAN ELECTION LAW

PRINTED NAME

PETITION

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STREET ADDRESS OR RURAL ROUTE

HIS OR HER OWNIS

MONTH

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SIGNATURE

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DATE OF SIGNING DAY YEAR

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The undersigned circulator of the above petition asserts that he or she is a qualified and registered elector of the electoral district of the official whose recall is sought; that each signature on the petition was signed in his or her presence and was not obtained through fraud, deceit or misrepresentation; and that he or she neither caused nor permitted a person to sign the petition more than once and has no knowledge of a person signing the petition more than once. The undersigned circulator of the above petition further asserts that to his or her best knowledge, information and belief each signature is the genuine signature of the person purporting to sign the petition; the person signing the petition was at the time of signing a qualified registered elector of the City or Township listed in the heading of the petition; arid the elector was qualified to sign the petition.

CIRCULATOR - DO NOT SIGN OR DATE CERTIFICATE UNTIL AFTER CIRCULATING PETITION.

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(Signature of Circulator) (Dale)

(Printed Name of CirciJlator)

WARNING-A CIRCULATOR KNOWINGLY MAKING A FALSE STATEMENT IN THE ABOVE CERTIFICATE,A PERSONNOTA CIRCULATORWHO SIGNSAS A CIRCULATOR,OR A PERSONWHO SIGNSA NAME OTHERTHAN HISOR HER OWN AS CIRCULATORIS GUlLTV OF A MISDEMEANOR.
Michigan Election Resources - Fonn No. 2011

(City or T~ship

Where Registered)

Complete Residence Address (Street and Number or Rural Route)

(ZIp Code)

2002

Revision

- Approved

by Slate Director

of Elections

!INSTRUCTIONSONREVERSESIDE!

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We, the undersigned, registered and qualified voters of the Township of}

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RECALL PETITION

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in the County of

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,and State of Michigan, petition tortl for the following reason(s):

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calling of an election to recall

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WARNING-A PERSON WHO KNOWINGLY SIGNS A RECALL PETITION MORE THAN ONCE OR SIGNS A NAME OTHER THAN HIS OR HER OWN IS VIOLATING THE PROVISIONS OF THE MICHIGAN ELECTION LAW
SIGNATURE PRINTED NAME STREET ADDRESS OR RURAL ROUTE ZIP CODE MONTH DATE OF SIGNING DAY YEAR

1. 2. 3.
4.

5. 6. 7. 8. 9. 10. 11. 12.

CERTIFICATE OF CIRCULATOR

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The undersigned circulator of the above petition asserts that he or she is a qualified and registered elector of the electoral district of the official whose recall is sought; that each signature on the petition was signed in his or her presence and was not obtained through fraud, deceit or misrepresentation; and that he or she neither caused nor permitted a person to sign the petition more than once and has no knowledge of a person signing the petition more than once. The undersigned circulator of the above petition further asserts that to his or her best knowledge, information and belief each signature is the genuine signature of the person purporting to sign the petition; the person signing the petition was at the time of signing a qualified registered elector of the City or Township listed in the heading of the petition; arid the elector was qualified to sign the petition.

CIRCULATOR - DO NOT SIGN OR DATE CERTIFICATE UNTIL AFTER CIRCULATING PETITION.

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(Signature of Circulator) (Date)

(Printed Name of Circulator)

WARNING-A CIRCULATOR KNOWINGLY MAKING A FALSE STATEMENT IN THE ABOVE CERTIFICATE, A PERSON NOT A CIRCULATOR WHO SIGNS AS A CIRCULATOR, OR A PERSON WHO SIG~A NAME OTHER THAN HIS OR HER OWN AS CIRCULATOR IS GUlLTV OF A MISDEMEANOR.
Michigan Bection Besources . Form No. 2011 2002 Revision - Approved by State Director of Elections

(City or Towj1ship Where Registered)

Complete Residence Address (Street and Number or Rural Route)

(Zip Code)

INSTRUCTIONS

ON REVERSE

SIDE

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We, the undersigned, registered and qualified voters of the~ShiP

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RECALL PETITION
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(District, if Any)

s,and State of Michigan, petition forti for the following reason(s):

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calling of an election to recall

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WARNING-A PROVISIONS

PERSON WHO KNOWINGLY SIGNS A RECALL OF THE MICHIGAN ELECTION LAW .

PRINTED NAME

PETITION

MORE THAN ONCE OR SIGNS A NAME OTHER THAN HIS OR HER OWNIS VIOLATING
STREET ADDRESS OR RURAL ROUTE ZIP CODE

THE

SIGNATURE

DATE OF SIGNING DAY MONTH YEAR

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.

CERTIFICATE OF CIRCULATOR

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The undersigned circulator of the above petition asserts that he or she is a qualified and registered elector of the electoral district otthe official whose recall is sought; that each signature on the petition was signed in his or her presence and was not obtained through fraud, deceit or misrepresentation; and that he or she neither caused nor permitted a person to sign the petition more than once and has no knowledge of a person signing the petition more than once. The undersigned circulator of the above petition futher asserts that to his or her best knowledge, information and belief each signature is the genuine signature of the person purporting to sign the petition; the person signing the petition was at the time of signing a qualified registered elector of the City or Township listed in the heading of the petition; arid the elector was qualified to sign the petition.

CIRCULATOR - DO NOT SIGN OR DATE CERTIFICATE UNTIL AFTER CIRCULATING PETITION.

I
(Signature of CirCUlator) (Date)

(Printed Name of CircOlator)

VVARNING-A CIRCULATOR KNOWINGLY MAKING A FALSE STATEMENT IN THE ABOVE CERTIFICATE,A PERSONNOT A CIRCULATORWHOSIGNSAS A CIRCULATOR,ORA PERSONWHO SIGNS A NAMEOTHERTHAN HIS OR HEROWNAS CIRCULATORIS GUILTYOF A MISDEMEANOR.
~k:I1igan Election Resources
#

(City or Tow:,ship

Where Registered)

Comp1eteResldence

Address (Street and Number or Rural Route)

(Zip Code)

Fonn No.

2011

2002

Revision - Approved

by State Director

of Elections

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WARNING-A PROVISIONS

PERSON WHO KNOWINGLY SIGNS A RECALL OF THE MICHIGAN ELECTION LAw.

PRINTED NAME

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THAN HIS OR HER OWN-IS

ZIP CODE 'MONTH

VIOLATING

THE

DATE OF SIGNING I DAY I YEAR

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CERTIFICATE OF CIRCULATOR

The undersigned circulator of the above petition asserts that he or she is a qualified and registered elector of the electoral district of the official whose recall is sought; that each signature on the petition was signed in his or her presence and was not obtained through fraud, deceit or misrepresentation; and that he or she neither caused nor permitted a person to sign the petition more than once and has no knowledge of a person signing the petition more than once, The undersigned circulator of the above petition further asserts that to his or her best knowledge, information and belief each signature is the genuine signature of the person purporting to sign the petition; the person signing the petition was at the time of signing a qualified registered elector of the City or Township listed in the heading of the petition; arid the elector was qualified to sign the petition.

CIRCULATOR - DO NOT SIGN OR DATE CERTIFICATE UNTIL AFTER CIRCULATING PETITION.

I
(Signature of Circulator) (Date)

(Printed Name. of Circulator)

WARNING-A CIRCULATOR KNOWINGLY MAKING A FALSE STATEMENT IN THE ABOVE CERTIFICATE, PERSONNOTA CIRCULATORWHOSIGNSAS A CIRCULATOR,OR A PERSONWHO A SIGNSA NAMEOTHER THANHIS OR HER OWN AS CIRCULATORIS GUILTY OF A MISDEMEANOR.
Michigan Election Resources - Form No. 2011 2002 Revision - Approved by State Director 01 EJections

(City or TOWilship Where Registered)

Complete Residence Address (Street and Number or Rural Route)

(Zip Code)