PETITION FOR INDEPENDENT CANDIDATE BALLOT ACCESS STATE OF ALABAMA
Pursuant to Section 17-9-3, Code of Alabama, 1975, as amended, I, the undersigned, am qualified elector
PLEASE PRINT YOUR INFORMATION CLEARLY AND LEGIBLY THEN SIGN:
First Name: _____________________________________________________________
Last Name: ______________________________________________________________
Street Address:____________________________________________________________
City/County: ____________________________ Date of Birth: ______________________
Signature: ________________________________________________________________