Jeff Staples for Delegate
 Progressive for the 81st Va. House

will help lead us out of the politics of the past and into the solutions of the future .
 We can solve the problems of healthcare, housing, energy, jobs and much more!

Thank you for signing a petition to help get Jeff on the General Election Ballot!

You must be a registered voter in the 81st Virginia House District in order to sign this petition. You can check your Voter Registration Status here (

Make sure you read the instructions below to ensure your petition form is filled out accurately and your signature is counted by the Virginia Board of Elections:

1.  Fill out  the form from the link below by following the instructions below.

2. When the page opens, click on the open with google docs tab at the top and middle of the page

3. Look for the section titled, " Petition Signer Statement," on the left hand side of the form. Fill in your City name above the line labeled, "County/City/Town."

4. Read the section titled, "Note to Petition Signer."

5. At the bottom of the form, fill out all sections in the box labeled "Petition Signer"

    You MUST type out your full legal name above the line labeled "Print Full Name"  AND above the line labeled "Signature."

    You MUST fill out the residential address in Virginia where you are registered to  vote, (Including the city/state/zip.)

    You MUST type the date that you signed the petition

    You MUST type out the last 4 digits of your social security number

5. Once you have filled out the entire form correctly, save to your local device by going to File in the left hand corner, click on it and then click on download as a PDF.  Next please, in an email  attach the file to

6. Please share this link with your friends, family and neighbors, Thank you!