You’ve Printed Your Petition, Now What?
You must be a registered voter in California to sign this Petition.
Not Registered? Visit: registertovote.ca.gov (prior to signing Petition)
Please use blue or black ink and print neatly
Your Name, Address and Signature MUST MATCH your voter registration information
DO NOT Write in the boxes to the right of the signature area
Each Petition may ONLY contain signatures from a SINGLE County
IMPORTANT: YOU ARE “The Circulator”. If you are completing at home or as a “Collector”,
YOU MUST COMPLETE ALL of the “Circulator” fields for Petition to be valid
Print & Display to other signers: the “Top Funders List” available at: recallgavin2020.com/officialtopfunders
One to five (8.5x11 letter form) or ten (8.5x14 legal form) signatures are acceptable (total completion of five
or ten signatures is not required)
Return completed Petitions to the PO Box located at the bottom of this form
Each of the undersigned states for himself/herself that he or she is a registered and qualified elector of the County on County Where Signatures Collected California
1. PRINT Name: Signature
SAMPLE: SAMPLE:
Print Your Name Here Signature as it appears on your voter card For Office Use Only:
Full Residence Address: No PO Box. (Please do not abbreviate city or street name) Do Not Write
SAMPLE: Here
Full Address as it appears on your voter card, No PO Box
2. PRINT Name: Signature
SAMPLE SAMPLE
For Office Use Only:
Do Not Write
Full Residence Address: No PO Box. (Please do not abbreviate city or street name) Here
SAMPLE
3. PRINT Name: Signature
SAMPLE SAMPLE
For Office Use Only:
Full Residence Address: No PO Box. (Please do not abbreviate city or street name) Do Not Write
Here
SAMPLE
4. PRINT Name: Signature
SAMPLE SAMPLE
For Office Use Only:
Full Residence Address: No PO Box. (Please do not abbreviate city or street name) Do Not Write
Here
SAMPLE
5. PRINT Name: Signature
SAMPLE SAMPLE
For Office Use Only:
Full Residence Address: No PO Box. (Please do not abbreviate city or street name) Do Not Write
Here
SAMPLE
IMPORTANT: DECLARATION OF PERSON CIRCULATING SECTION OF RECALL PETITION:
(MUST BE IN CIRCULATOR'S OWN HANDWRITING)
I Your Full Name Here_________ solemnly swear (or affirm) all of the following: (1) That I am 18 years of age or older. (2) That my residence
address, including street and number is Your Full Address Here (If no street or number exists, a designation of my residence
adequate to readily ascertain its location is For Collectors Without a Physical Address ). (3) That the signatures on this section of
the petition were obtained between the dates of _Start _/_Date_/ 2020, and _End_/_Date_/ 2020; that I circulated the petition and I witnessed the
signatures on this section of the petition form being written; and that, to the best of my information and belief, each signature is the genuine signature of
the person whose name it purports to be. (4) That I showed each signer a valid and unfalsified “Official Top Funders” sheet, as required by Elections
Code Section 107.
I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Executed on _Month_/_Date_/ 2020, at (City or Community where signed) City Where Signatures Were Collected , California.
Signature of Circulator: _____Full Signature Here________________Date_00/00/0000 Here_
*Download Petition/Instructions at: RecallGavin2020.com
*Mail Petitions to California Patriot Coalition PO BOX 417030 Sacramento CA 95841
