Page 37 - Special District Handbook with Cover-Final

EXHIBIT E EXAMPLE

INITIATIVE MEASURE TO BE SUBMITTED DIRECTLY TO THE VOTERS

(INSERT NAME OF DISTRICT) _______________________

Notice of Intention to Circulate Petition (See pages 4 and 5 for more information)

Notice is hereby given of the intention of the persons whose names appear hereon of their intention to circulate the petition within ___________ District for the purpose of (insert purpose of measure) . A statement of the reasons of the proposed action as contemplated in the petition is as follows:

(INSERT REQUIRED STATEMENT OF REASONS NOT TO EXCEED 500 WORDS)

NOTICE TO THE PUBLIC

THIS PETITION MAY BE CIRCULATED BY A PAID SIGNATURE GATHERER OR A VOLUNTEER. YOU HAVE THE RIGHT TO ASK. THE USE OF YOUR SIGNATURE FOR ANY OTHER

PURPOSE OTHER THAN QUALIFICATION OF THIS MEASURE FOR THE BALLOT IS A MISDEMEANOR. COMPLAINTS ABOUT THIS MISUSE OF YOUR SIGNATURE MAY BE MADE TO

THE SECRETARY OF STATE’S OFFICE.

Office Use Only 1.

PRINT NAME

RESIDENCE ADDRESS ONLY

SIGNATURE

CITY ZIP

2.

PRINT NAME

RESIDENCE ADDRESS ONLY

SIGNATURE

CITY ZIP

DECLARATION OF PERSON CIRCULATING SECTION OF INITIATIVE PETITION

(MUST BE IN CIRCULATOR’S OWN HANDWRITING)

(Completed after above signatures have been obtained. See pages 8-9 for more information)

I ________________________ Declare: (print name)

1. My residence address is _________________________________in ____________County, California and I am a voter or qualified to vote in (insert electoral jurisdiction); 2. I personally circulated the attached petition for signing.

3. I witnessed each of the appended signatures being written on the petition and to my best information and belief, each signature is the genuine signature of the person whose name it purports to be; and 4. The appended signatures were obtained between the dates of ________and _________ inclusive.

(starting date) (ending date)

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Executed on __________________, 20___ at ______________________, California.

(month and day) (city where signed)

__________________________________________ (signature of circulator)

It is recommended that you leave a 1” margin at the top, and a ½” margin on the left, right and bottom.

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