Wyoming Petition For Formation Of The Political Party

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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. W.S. 22-4-402

Provisional Party Officers: (Please Print)

Chairperson: ________________________________________________________________________________________________________________________

Name

Address

E-mail

Phone

Treasurer: ___________________________________________________________________________________________________________________________

Name

Address

E-mail

Phone

INSTRUCTIONS FOR SIGNERS:

You must be registered to vote in Wyoming to sign this petition.



Your name and address on this petition must match the current voter registration list.



(No P.O. Boxes)

Date

Printed Name

Signature

City/Town

Wyoming Residence Address ONLY

10.

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

Signature

Residence Address

City/State/Zip