___________________ signature pages bearing _____________ signatures for initiative (referendum) petition serial number ____ have been refused for filing in this office as provided by law. A total of ________________ signatures included on the remaining petition sheets were found to be ineligible. Of the total random sample of _______________ signatures, a total of __________ signatures were invalidated by the county recorders resulting in a failure rate of _________ percent. The actual number of remaining signatures for such initiative (referendum) petition number ________ are equal to or in excess of the minimum required by the constitution to place a measure on the general election ballot. The number of valid signatures filed with this petition, based on the random sample, appears to be at least one hundred percent of the minimum required or through examination of each signature has been certified to be greater than the minimum required by the constitution.
Date:_______________________ _______________________________
Secretary of State
(Seal)
The secretary of state shall then forthwith notify the governor that a sufficient number of signatures has been filed and that the initiative or referendum shall be placed on the ballot in the manner provided by law.
A facsimile of the certifications of the county recorders under section 19-121.02 shall accompany the signature sheets returned to the person or organization that submitted them.
A.R.S. § 19-121.04