Affidavit of Signature Gatherer

I, ________________________________________, (name of person who is the signature gatherer), swear that I gathered the signatures on the petition to which this affidavit is attached, that I believe the signatures on the petition are genuine, are the signatures of the persons whose names they purport to be, and are the signatures of Montana electors who are registered at the address or have the telephone number following the person’s signature, and that the signers knew the contents of the petition before signing the petition.

__________________________________________
Date on which the first signature was gathered

__________________________________________
Signature of petition signature gatherer

__________________________________________
Address of petition signature gatherer

__________________________________________
City, state and zip code

STATE OF MONTANA )
County of ________________ )

Subscribed and sworn to before me this ________ day of __________________, 20_______.

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Signature of notary public or other person authorized to take oaths

________________________________________________________________________
Typed, stamped, or printed name of notary public or other person authorized to take oaths

Notary Public for the State of Montana

Residing at_________________________________
(city or town of residence)

My Commission Expires_____________________, 20________

SEAL