TEXIT Petition 2023 - Democratic Party
Name: Address: County: Birthdate:
This section is for the petition circulator only. It is required by law (Texas Election Code 141.063) to be on the same page as the signature of the petition signer. As the petition signer, you can skip this section and continue to the bottom of the form to complete your signature.
AFFIDAVIT OF CIRCULATOR | STATE OF TEXAS COUNTY OF _______________________________________
BEFORE ME, the undersigned, on this ___/___/___ (date) personally appeared __________________________________, who being duly sworn, deposes and says: “I pointed out and read to each signer, before the petition was signed, each statement pertaining to the signer that appears on the petition. I witnessed each signature. The correct date of signing is shown on the petition. I verified each signer’s registration status and believe that each signature is the genuine signature of the person whose name is signed and that the corresponding information for each signer is correct.”
SWORN TO AND SUBSCRIBED BEFORE ME ON THIS DATE
X _________________________________________Signature of circulator
X ________________________________________Signature of officer administering oath
X ________________________________________Title of officer administering oath
I, , hereby acknowledge that I am a registered voter in the State of Texas and the information I have provided on this petition is true and correct. It was read and pointed out to me that the purpose of this petition is to place a referendum on the 2024 general primary ballot for the DEMOCRATIC PARTY that states, ‘The State of Texas should reassert its status as an independent nation. FOR OR AGAINST’ and I understand that by signing this petition, I become ineligible to vote in a primary election or participate in a convention of another party, including a party not holding a primary election, during the voting year in which this primary election is held.
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Document Name: TEXIT Petition 2023 - Democratic Party
Agree & Sign