"STATE OF ARKANSAS
COUNTY OF ...............
"The undersigned, duly qualified electors of the City of ..............., Arkansas, each signer herein petitions that the name of ............... be placed on the ballot as a candidate for election to Position No. ............... on the Board of Directors (or Mayor) of said City of ............... at the next general election for the office of director or mayor to be held in such city on the............... day of ............... 20............... We further state that we know said person to be a qualified elector of said city and a person of good moral character and qualified in our judgment for the duties of such office.
Printed Name: __________________
Signature __________________
Residential Street Address __________________
Date of Birth __________________
Date of Signing __________________";
Ark. Code § 14-48-109