1. A petition for a referendum shall be in substantially the following form:

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WARNING
It is a felony for anyone to sign any initiative or referendum petition with any name other than his own, or to knowingly sign his name more than once for the measure, or to sign such petition when he is not a legal voter.
INITIATIVE PETITION
To the board of directors of the ______ Fire Protection District:
We the undersigned, citizens and voters of the state of Missouri and the ______ Fire Protection District, respectfully order that (describe the measure) shall be referred to the people of the district for their approval or rejection, at the regular (special) election to be held on the ______ day of ______, 20______, and each for himself says: I have personally signed this petition; I am a duly qualified elector of the state and district; my residence and post-office address are correctly written after my name.
Name ______ Residence ______ Post Office ______
(if in a city, street and number)
(Here follow numbered lines for signatures.)

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2. Every sheet for petitioners’ signatures shall be attached to a full and correct copy of the title and text of the measure proposed by the initiative petition. Referendum petitions shall be attached to a full and correct copy of the measure on which the referendum is demanded.

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Terms Used In Missouri Laws 321.495

  • Affidavit: A written statement of facts confirmed by the oath of the party making it, before a notary or officer having authority to administer oaths.
  • board: as used in this chapter shall mean the board of directors of a fire protection district. See Missouri Laws 321.010
  • fire protection district: is a political subdivision which is organized and empowered to supply protection by any available means to persons and property against injuries and damage from fire and from hazards which do or may cause fire, and which is also empowered to render first aid for the purpose of saving lives, and to give assistance in the event of an accident or emergency of any kind. See Missouri Laws 321.010
  • following: when used by way of reference to any section of the statutes, mean the section next preceding or next following that in which the reference is made, unless some other section is expressly designated in the reference. See Missouri Laws 1.020
  • Oath: A promise to tell the truth.
  • person: may extend and be applied to bodies politic and corporate, and to partnerships and other unincorporated associations. See Missouri Laws 1.020
  • State: when applied to any of the United States, includes the District of Columbia and the territories, and the words "United States" includes such district and territories. See Missouri Laws 1.020
  • voter: is used in the laws of this state it shall mean registered voter, or legal voter. See Missouri Laws 1.035

3. Each sheet of every petition containing signatures shall be verified in substantially the following form by the person who circulated the sheet, by his affidavit thereon:

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State of Missouri
County of ______
I, ______, being first duly sworn, say that each person whose name appears on this sheet signed his name thereto in my presence; I believe that each has stated his name, post-office address and residence correctly, and that each signer is a voter of the state of Missouri and ______ Fire Protection District.
(signature and post-office address of affiant)
Subscribed and sworn to before me this ______ day of ______, 20______
(signature and title of officer before whom oath is made and his post-office address)

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