Page 34 - Special District Handbook with Cover-Final

EXHIBIT B

EXAMPLE

NOTICE OF INTENTION TO CIRCULATE PETITION

Notice is hereby given of the intention of the persons whose names appear hereon of their intention to circulate the petition within the ________ District for the purpose of qualifying for the ballot an initiative measure entitled _______________ ____________________________________. A statement of the reasons of the proposed action as contemplated in the petition is as follows:

(Insert REQUIRED Statement of Reasons for initiative not to exceed 500 words)

*____________________________ (Printed Name of Proponent)

____________________________ (Signature of Proponent)

_____________________________ (Business or Residence Address)

_____________________________ (City/State/Zip Code)

*The Notice of Intention must be signed by at least one but not more than five proponents of the petition.

NOTE: The Notice of Intention must include the Statement of Reasons and be accompanied by a Statement of Acknowledgement.

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