Make your own free website on Tripod.com
Petition Page
Democratic Socialist Party of Southwest Missouri

Home | Mission | Latest News | The Issues | How to Get Involved | Petition Page | Links | Calendar of Events | Contact Us | New Page Title

Please Print and get signatures...

Petition for Placing a New Party on the Ballot, To the Honorable Secretary of the State of Missouri

We, the undersigned, citizens and registered voters, of the state of Missouri, Greene County, and the 138th State Representative District, respectfully order that the Democratic Socialist Party and its candidates be placed on the ballot, for election or rejection to such public offices at the next election, to be held on the 6th day of August, 2004, and each for himself or herself says: I have personally signed this petition; I am a registered voter of the State of Missouri, Greene County and the 138th State Representative District, my registered voting address and the name of the city, town or village in which I live are correctly written after my name.

CIRCULATORS AFFIDAVIT STATE OF MISSOURI, COUNTY OF GREENE, (Circulators Registered voting name) I,___________ _____________________, a resident of the state of Missouri, being first duly sworn, say: The following signatures of registered voters of the 138th State Representative District of the state of Missouri, signed this page of the forgoing petition, and each of them signed his/her name thereto in my presence; I believe that each has stated his/her name, registered voting address and city, town, or village correctly, and that each signer is a registered voter of the state of Missouri and Greene County and the 138th District. (Circulators signature)__________________,

Date_________, Address and Zip Code_______________________________, 7th Congressional District.

Registered Voter

Printed Name Date Address, City, Zip Signature

1.____________________________________________________________________________

2_____________________________________________________________________________

3.____________________________________________________________________________

4.____________________________________________________________________________

5.____________________________________________________________________________

6_____________________________________________________________________________

7.____________________________________________________________________________

8.____________________________________________________________________________

9.____________________________________________________________________________

10____________________________________________________________________________

11.___________________________________________________________________________

12.___________________________________________________________________________

13____________________________________________________________________________

14____________________________________________________________________________

15____________________________________________________________________________

16____________________________________________________________________________

17____________________________________________________________________________

18____________________________________________________________________________

19____________________________________________________________________________

20____________________________________________________________________________

Notarization

(signature of Circulator of petition)_________________________, Address__________________

_______________________________, subscribed and sworn before me this ______day of ______

__________A.D., Signature of Notary Public____________________________(Seal)__________.

My Commission expires___________________________________________________________

Enter content here

Enter supporting content here