§ Ark. Code § 7-9-109Form of verification — Penalty for false statement

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(a) Each petition containing signatures shall be verified in substantially the following form by
the canvasser’s affidavit thereon as a part thereof:
“State of Arkansas
County of ________
I, (print name of canvasser), being duly sworn, state that each of the foregoing persons signed
his or her own name to this sheet of the petition in my presence. To the best of my knowledge and
belief, each signature is genuine and each signer is a registered voter of the State of Arkansas,
________ County, or City or Incorporated Town of ________. At all times during the circulation of
this signature sheet, an exact copy of the popular name, ballot title, and text was attached to the
signature sheet, and each signer read the ballot title of the petition or had the ballot title of the
petition read to the signer in my presence. My current residence address is correctly stated below.
Signature ___________________________________________
Current residence _______________________________________
Indicate one: ____ Paid Canvasser ____ Volunteer/Unpaid Canvasser
Subscribed and sworn to before me this ____ day of ________, 20____
Signature __________________________________________
Clerk, Notary, Judge, or J.P.
Seal _____________________”.
(b) Forms herein given are not mandatory, and if substantially followed in any petition it shall
be sufficient, disregarding clerical and merely technical errors.
(c)(1) Petitions shall not be disqualified due to clerical or technical errors made by a clerk,
notary, judge, or justice of the peace when verifying the canvasser’s signature.
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INITIATIVES, REFERENDA, ETC.
7-9-111
(2) Petitions shall not be disqualified for failure of a clerk, notary, judge, or justice of the peace
to sign exactly as his or her name appears on his or her seal if the signature of a clerk, notary,
judge, or justice of the peace is sufficient to verify his or her name.
(d) A canvasser who knowingly makes a false statement on a petition verification form
required by this section shall be deemed guilty of a Class D felony.
(e) A canvasser who witnesses signatures on a petition part but knowingly allows another
canvasser who did not witness all signatures on a petition part to execute a false verification
affidavit with respect to that petition part commits a Class D felony.
(f) A sponsor, sponsor’s agent, or representative commits a Class D felony if a sponsor,
sponsor’s agent, or representative:
(1) Knowingly pays a canvasser for petitioner signatures on a petition part not personally
witnessed by that paid canvasser; or
(2) Knowingly submits to the Secretary of State a petition part where the verifying canvasser
has not witnessed each signature on that petition part.
(g)(1) A canvasser who witnesses signatures on a petition part shall view a copy of a potential
petitioner’s photo identification to verify the identity of the potential petitioner before obtaining
the signature.
(2) If a canvasser cannot verify the identity of the potential petitioner, the canvasser shall not
obtain a signature from the potential petitioner.
(3) A canvasser who submits a canvasser affidavit under subsection (a) of this section swearing
that to the best of the affiant’s knowledge and belief each signature is genuine, and that the
person signing is a legal voter, but does not comply with the requirements under subdivision
(g)(1) of this section, makes a false statement on a petition verification form.
(4) As used in this subsection, “photo identification” means a document or identification card
permitted under § 7-1-101(40).

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