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