VerifyTheRecall

InstructionstoCompleteAffidavitofNonSignature
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Confirmyourdesiretocontestarecallsignature.Itisacrimetoknowinglyfalsifyinformationonanaffidavit.
Findthesignature youwishtocontest inVTRs online database.ClickView Petition toview theoriginal recall
petition.YouwillneedinformationfromtheoriginalrecallpetitioninStep10below.
Withapen,fillintheaffidavitfields,butDONOTSIGNTHEAFFIDAVITYET!
ListthecountyinwhichyouresideintheheaderoftheaffidavitnexttoCOUNTY.
Listyournameintheblankinthesentencethatreads:I,
[name]
,beingfirstdulysworn
Inline#1,writeyourfulllegalname(First,Middle,andLastnames).
Inline#2,writeyourfulladdress(streetaddress,city,state,andzipcode).
In line #3, write the title and name of the official being recalled in which you discovered the fraudulent
signature. If you discovered the fraudulent signature in the recall petitions for Governor Scott Walker, write
GovernorScottWalker.IfyoudiscoveredthefraudulentsignatureintherecallpetitionsforaStateSenator,
writeStateSenator[PoliticiansName](forexample,StateSenatorPamGalloway).
Inline#4,writethetitleandnameoftheofficialforwhichyouconfirmyoudidnotsignarecallpetition.(The
titleandnamewritteninline#4shouldbeidenticaltothetitleandnamewrittenforline#3.)
Inline#5,entertwoitemsfromtherecallpetitiononwhichyoufoundthefraudulentsignature:
a. In the first blank, write the GAB page number. This is found in a box near the bottom of the recall
petitionwiththelabelPageNo.(OfficialUseOnly).Thenumberissixdigitslong.
b. Inthesecondblank,writethelinenumberinwhichthesignatureyouarecontestingisfound.
STOPFILLINGINAFFIDAVITFIELDS!
Locate,contact,andmeetwithaNotaryPublicinyourarea.
a. TosearchforaNotaryPublicinyourarea,visithttp://dfi.nmtvault.com/Notary.aspx
Completethebalanceoftheform(date,signature,etc.)onlywhenyouareinthepresenceoftheNotaryPublic.
a. MakesuretoallowtheNotaryPublictosignanddatehis/hersectionoftheaffidavit.
Immediatelysendyourcompletedaffidavitto:

VerifyTheRecall
c/oWethePeopleoftheRepublic
POBox46573
Madison,WI53744

YouraffidavitcontestingafraudulentsignaturewillbesubmittedtotheGABbyVerifyTheRecall.

AFFIDAVIT
STATE OF WISCONSIN
__________ COUNTY

)
) ss.
)

I, ________________

_, being first duly sworn, depose and state as follows:

1.

My full legal name is ____________________________________.

2.

I am a resident of the State of Wisconsin and I reside at

____________________________________________________________.
3.

I am aware that certain petitions were circulated with respect to the recall

of ________________________________
4.

___.

I hereby swear and affirm that I did not sign any petition in support of the

recall of ________________________________
5.
line ___
6.

Dated this

___.

I have reviewed the petitions and found an entry on page ___

_,

_, which appears to be my name and address.

This is not my signature.

day of

, 2012.

Signature:*________________
Print Name: ________________
Subscribed and sworn to before me
this
day of

, 2012.

_____________________________
Notary Public, State of Wisconsin
My Commission Expires:_________
*Please do not sign this affidavit until you are in the presence of a Notary Public.
IT IS A CRIME TO FALSIFY INFORMATION ON THIS FORM.

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