STATE OF MISSISSIPPI
County of ____
I, ____, a qualified elector of said county do now state under oath that every person who signed the foregoing petition signed his or her name thereto in my presence, and that before the signing of said petition the signator was told that after signing the same his or her name could not be removed from said petition; that I believe that each has stated his or her name and precinct correctly, and that so far as I know each signer is a qualified elector of this county, and I further certify that the date appearing on the foregoing petition is the correct date on which the first signature was affixed to said petition or any section thereof.
Sworn to and subscribed before me, this ____ day of ____, 20____.
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