Wyoming Petition for Formation of the _________________________________ Political Party
I know the contents of this petition including the names of the provisional party officers and request that the _______________________ party be printed on the ballot for the next general election. I am a registered elector for the next primary and general election. Provisional Party Officers: (Please Print) Chairperson: _______________________________________________________________________________________
Name Address E-mail Phone
Treasurer:__________________________________________________________________________________________
Name Address E-mail Phone
INSTRUCTIONS FOR SIGNERS
· You must be a Wyoming registered voter to sign this petition. · Your name and address on this petition and your name and address on the current voter registration list should match.
Date 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.
Printed Name
Signature
Residence Address
City/Town
VERIFICATION BY CIRCULATOR
I, , do hereby certify that I am a circulator of this petition, and I solely and personally circulated this petition, that all the signatures appearing herein were made in my presence from ,(month) , (day) (year) through , (month) , (day) (year), and to the best of my knowledge and belief such signatures are those of the persons whose names they purport to be. Print Name Residence Address Signature City, State, Zip
(Petition for Political Party / Revised 2/09) f/Pagemaker Forms/elections/2010 Forms/Petition for Political Party