STATE OF NEVADA
COUNTY OF _____________
I, __________ (print name), being first duly sworn under penalty of perjury, depose and say:
_________________________________
Signature of circulator
Subscribed and sworn to or affirmed
before me this ____ day of ____, _____.
_______________________________
Notary public or other person licensed
to administer an oath
Nev. Admin. Code § 293.182
NRS 293.124, 293.247