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A. Signature Withdrawal. An eligible voter who has signed an application or petition may, by executing and filing with the Office an affidavit in the form prescribed by this section within ten (10) business days from the day on which the application or petition is filed with the Office, withdraw his or her signature from the application or petition. Any signature so withdrawn shall not be counted in determining the legal sufficiency of the petition. The affidavit shall:

1. Be signed and sworn to before a notary public;

2. Be in the given name and surname of the affiant;

3. State the affiant’s residence address, giving street and number, if any, his or her post office address and the referendum number of the application or petition which he or she signed; and

4. Affirm the affiant’s intention to withdraw his or her signature from the application or petition.

B. The affidavit shall be provided by the Office. ONCA 17-107, eff. Oct. 4, 2017.