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LEGISLATIVE PETITION

First Name:
Last Name:
Street Address:
City:
State:
Zip:
Email Address:
Cell Number:
My Driver's License Number
I hereby attest that the information entered into this dynamic form is true and accurate.
Sign Here (Type Full Name):
PrintName:
Date:
I hereby certify that my electronic signature is to be treated as an original signature, and that I have NOT submitted this Petition more than once. I certify that my cell phone number listed above belongs to me, and to no one else.
I hereby authorize the presentment of this Petition to All House & Senate Elected Officials by email delivery, or other delivery method.
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