The petition shall be in the following form:
Petition for Local Option Election
We, the undersigned legally qualified voters, resident within the county (municipality) of_______________, do hereby petition that a special election be held within the county (city, town) of __________________ on the at the date of the next regularly scheduled primary or general election upon the following question:
Shall the sale of alcoholic beverages under the West Virginia Alcohol Beverage Control Commissioner be (permitted) (prohibited) in __________________?
Name Address Date
(Post office or street and number)