Form 32-A "Statement of Circulator or Committee in Charge of an Initiative, Referendum, or Supplementary Petition" - Ohio

What Is Form 32-A?

This is a legal form that was released by the Ohio Secretary of State - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2017;
  • The latest edition provided by the Ohio Secretary of State;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 32-A by clicking the link below or browse more documents and templates provided by the Ohio Secretary of State.

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Download Form 32-A "Statement of Circulator or Committee in Charge of an Initiative, Referendum, or Supplementary Petition" - Ohio

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Form No. 32-A Prescribed by Secretary of State (09-17)
Statement of Circulator or Committee
print clearly
in Charge of an Initiative, Referendum, or Supplementary Petition
To be filed with the Secretary of State within 30 days after such petition papers are filed.
R.C. 3517.12(B)
Statement of
Committee
Circulator Name and Committee Name or Committee Name
Dated this
day of
,
.
Day
Month
Year
The undersigned states that he/she is the
Circulator or Committee Representative
of
Petition(s), and that the following itemized statement shows in
Initiative, Referendum or Supplementary
detail (1) All money or things of value paid, given, promised, or received for circulating the petition; (2) All appointments,
promotions, or increases in salary, in positions which were given, or promised, or received, or to obtain which assistance was
given, promised, or received as a consideration for work done in circulating petitions; (3) Full names and addresses, including
street, city, and state, of all persons to whom such payments or promises were made and of all persons from whom such
payments or promises were received; (4) Full names and addresses, including street, city, and state, of all persons who
contributed anything of value to be used in circulating such petition and the amounts of those contributions; (5) Time spent and
salaries earned while soliciting signatures to such petition by persons who were regular salaried employees of some person or
whom that employer authorized to solicit as part of their regular duties; or, (6) If no money or things of value were paid or
received or if no promises were made or received as consideration for work done in circulating a petition, a statement to that
effect.
Full name and address of all persons to whom money or things of value were paid, given, promised or received,
including any appointments, promotions, or increases in salary, for circulating petitions.
WHAT PAID, GIVEN,
AMOUNT, POSITION, OR
NAME
ADDRESS
PROMISED, OR RECEIVED
OTHER THING OF VALUE
Full name and address of all persons who contributed anything of value to be used in circulating petition.
DATE
NAME
ADDRESS
WHAT CONTRIBUTED
AMOUNT
Form No. 32-A Prescribed by Secretary of State (09-17)
Statement of Circulator or Committee
print clearly
in Charge of an Initiative, Referendum, or Supplementary Petition
To be filed with the Secretary of State within 30 days after such petition papers are filed.
R.C. 3517.12(B)
Statement of
Committee
Circulator Name and Committee Name or Committee Name
Dated this
day of
,
.
Day
Month
Year
The undersigned states that he/she is the
Circulator or Committee Representative
of
Petition(s), and that the following itemized statement shows in
Initiative, Referendum or Supplementary
detail (1) All money or things of value paid, given, promised, or received for circulating the petition; (2) All appointments,
promotions, or increases in salary, in positions which were given, or promised, or received, or to obtain which assistance was
given, promised, or received as a consideration for work done in circulating petitions; (3) Full names and addresses, including
street, city, and state, of all persons to whom such payments or promises were made and of all persons from whom such
payments or promises were received; (4) Full names and addresses, including street, city, and state, of all persons who
contributed anything of value to be used in circulating such petition and the amounts of those contributions; (5) Time spent and
salaries earned while soliciting signatures to such petition by persons who were regular salaried employees of some person or
whom that employer authorized to solicit as part of their regular duties; or, (6) If no money or things of value were paid or
received or if no promises were made or received as consideration for work done in circulating a petition, a statement to that
effect.
Full name and address of all persons to whom money or things of value were paid, given, promised or received,
including any appointments, promotions, or increases in salary, for circulating petitions.
WHAT PAID, GIVEN,
AMOUNT, POSITION, OR
NAME
ADDRESS
PROMISED, OR RECEIVED
OTHER THING OF VALUE
Full name and address of all persons who contributed anything of value to be used in circulating petition.
DATE
NAME
ADDRESS
WHAT CONTRIBUTED
AMOUNT
Full name and address of all persons who were regular salaried employees of some person or whom that
employer authorized to circulate petition as part of their regular duties, together with time spent and salaries
earned while so doing.
TIME SPENT
NAME
ADDRESS
SALARY EARNED
(Total Hours)
WHOEVER COMMITS ELECTION FALSIFICATION IS GUILTY OF A FELONY OF THE FIFTH DEGREE
I,
, declare under penalty of election falsification that I am a
Printed Name of Circulator
for the
Committee,
Circulator or Representative
Committee Name
and that the foregoing is a full, true and itemized statement of the full names and addresses of all persons to whom money or
things of value were paid, given, promised or received for circulating the petitions; all appointments, promotions or increases in
salary, in positions which were given or promised, or to obtain which assistance was given, promised, or received as a
consideration for work done in circulating petitions; and the time spent and salaries earned while soliciting signatures to petitions
by persons who were regular salaried employees of some person or whom that employer authorized to solicit for or circulate the
petition as part of their regular duties.
Signature
Street and Number or Rural Route
City or Post Office and Zip Code
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