Petition Instructions

  1. Please write in the County in the line provided at the top of the page just above the 9 lines for voter signatures.  Only voters in that specified county may sign this petition. If someone from a different county signs the petition, it invalidates all the signatures on the page. Use a new petition for a different county.
  2. The circulator may sign their own petition form. [Only registered voters can sign petitions & only registered voters can circulate petitions. 
  3. Use black or blue pen only.
  4. Fill out the petition from top to bottom legibly.
  5. Please ensure each voter fills out ALL the information correctly.
  6. A voter may only sign the Heartbeat petition one time.  (There is another pro-life petition for a dismemberment bill.  You may sign both.)
  7. The 1st block is the signature and the 2nd block is the printed name. Do not mix the two.
  8. After signing, print your FULL name (same as on their driver’s license), address, and today’s date.
  9. Write address where registered to vote. May NOT use a P.O. Box.
  10. Date is the actual date of the signature, NOT a birth date. Date format example: 10/25/2019.
  11. Fill out bottom right portion AFTER circulating, regardless of the number of signatures gathered.
  12. If a mistake is made, put a single line through any mistake and make the correction above.
  13. Don’t make copies of the petitions.  If you would like more petitions, request them here:

In addition to having all the registered voters in your household sign the petition, please ask a friend, neighbor, or co-worker to add their signature as well.  Only circulate petitions where allowed. Ask permission when necessary. If you are on public property, you must be at least 6 feet from an establishment’s door. Please consider a donation of any size.

Mail petitions to:
The Michigan Heartbeat Coalition
P.O. Box 136
Belmont, MI 49306

sample petition