(a) At any time prior to the date an application for recall petition or a recall petition is filed for verification, an elector who has signed the application or the recall petition form may request withdrawal of his or her signature from the application or recall petition by executing and filing an affidavit, in the form prescribed by this Code section, with the election superintendent. Any signature so withdrawn shall not be counted in determining the legal sufficiency of the application or recall petition. The affidavit shall:

(1) Be signed and sworn to before a notary public;

(2) State the elector's residence address, giving number and street or route and city, the name of the county of residence, and, in the case of a recall application or petition, the number of the recall application or petition which he or she signed; and

(3) Affirm the elector's intention to withdraw his or her signature from the application or recall petition.

(b) The affidavit shall be substantially in the following form:

AFFIDAVIT OF SIGNATURE WITHDRAWAL

State of Georgia

County of

I, (Name as it appears on the application or recall petition),

being first duly sworn, say that I am an elector of the (electoral

district) in which the recall election will be conducted.

That my residence address is

(Number and street or route) (City)

That I signed or caused to be signed the application or the petition for

the recall of (Name and office of person sought to be recalled) and

that the recall application or petition has been assigned number .

That it is my intention by the signing and filing of this affidavit to

withdraw my signature therefrom.

Signature of elector

Subscribed and sworn to

before me this

day of , .

Notary public

, Georgia

My commission expires on the day of , .