Utah Code § 10-2-701.5

Form of petition
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A petition for municipal disincorporation shall substantially comply with, and be circulated in, the
following form:

PETITION FOR MUNICIPAL DISINCORPORATION
 To the Honorable District Court of ____ County, Utah:
 We, the undersigned citizens and legal voters of the State of Utah, and residents of ____
City, Utah, respectfully petition the Court to submit a proposal to disincorporate ____ City, Utah, to
the legal voters resident within said city for their approval or rejection at a special election ordered
held by the court for that purpose; and each signator for himself or herself says: I have personally
signed this petition; I am a legal voter of the State of Utah; I am a resident of ____ City, Utah, and
my residence and post office address are correctly written after my name.
WARNING TO SIGNERS WITH PRIVATE VOTER REGISTRATION RECORDS
If you sign this petition, your voter identification number and the date you signed may be publicly
disclosed. This disclosure may occur even if you are an at-risk voter with a voter registration record
that has been classified as a private record.

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