05:02:19:10Voters' petition for recount in close municipal

or school ballot question election. The voters' petition for recount in a close municipal or school ballot question election shall be filed with the person in charge of the election and shall be in the following form: VOTERS' PETITION FOR RECOUNT IN MUNICIPAL OR SCHOOL BALLOT QUESTION ELECTION WE, THE UNDERSIGNED qualified voters of the ______________ School District or the municipality of __________________, believe that a recount will change the outcome of the official returns for the following question, _____________________________, and we petition for a recount of all votes cast for the question at the election held on the _______ day of __________, _____. (Signed) ________________________ (Signed) ________________________ (Signed) ________________________ STATE OF SOUTH DAKOTA) ) ss. VERIFICATION COUNTY OF _____________) We, under oath, state that we read and signed the foregoing petition and know its contents and that, to the best of our knowledge and belief, the statement is true. (Signed) ________________________ (Signed) ________________________ (Signed) ________________________ Sworn to before me this _____ day of ___________, 20___. (Seal) ______________________________ Officer Administering Oath My Commission Expires ____________ ______________________________ Title of Officer Administering Oath

Source: 28 SDR 99, effective January 17, 2002.