Petition Signatures

Thank you for collecting signatures to help get Chuck Smith on the ballot for U.S. Senate! Click here or on the image or button below to download the Official Petition for Signatures of Registered Virginia Voters form:

Printable PDF


  • The form is double-sided and must be printed double sided.
  • The form can be printed in color, grayscale, or black and white.
  • Please use a separate petition form for qualified voters in each county or city.
  • The third page, “Virginia Petition of Qualified Voters Instructions” does not get submitted, and does not need to be printed.
  • The Circulator Affidavit on the reverse side must be completed and signed in front of a Notary. Do not fill out any part of the Circulator Affidavit unless you are in front of a Notary.

Please return all completed and notarized forms to Chuck Smith for Senate, P.O. Box 66545, Virginia Beach, VA 23466. If you have any questions, please contact the campaign by email or by phone at (757) 271-6963.

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