(a) Each petition containing signatures shall be verified in substantially the following form by the canvasser's affidavit thereon as a part thereof:

"State of Arkansas, County of ___________________

I, ___________________ (print name of canvasser) ___________________, being duly sworn, state that each of the foregoing persons signed his or her own name to this sheet of the petition in my presence. To the best of my knowledge and belief, each signature is genuine and each signer is a registered voter of ___________________ County, or City or Incorporated Town of ___________________. At all times during the circulation of this signature sheet, an exact copy of the popular name, ballot title, and text was attached to the signature sheet. My current residence address is correctly stated below.

Signature_________________

Residence ___________________________________

Indicate one: __________ Paid Canvasser __________ Volunteer/Unpaid Canvasser

Subscribed and sworn to before me this _____day of __________, 20_____

Signature_________________

Clerk, Notary, Judge, or Justice of the Peace

Seal___________________ ".

(b)

(1) If the form under this section is substantially followed in a petition, it is sufficient.

(2) The form shall not be held insufficient for clerical and merely technical errors.

(c)

(1) Petitions shall not be disqualified due to clerical or technical errors made by a clerk, notary, judge, or justice of the peace when verifying the canvasser's signature.

(2) Petitions shall not be disqualified for failure of a clerk, notary, judge, or justice of the peace to sign exactly as his or her name appears on his or her seal if the signature of a clerk, notary, judge, or justice of the peace is sufficient to verify his or her name.

(d) A canvasser or paid canvasser who knowingly makes a false statement on a petition verification form required by this section shall be deemed guilty of a Class D felony.