Page 39 - Special District Handbook with Cover-Final

EXHIBIT G

PERSON, COMPANY OFFICIAL, OR OTHER ORGANIZATIONAL OFFICER IN CHARGE OF SIGNATURE GATHERING

STATEMENT OF ACKNOWLEDGEMENT

I, _____________________________________________ acknowledge that it is a misdemeanor under State Law (Section 18650 of the California Elections Code) to knowingly or willfully allow the signatures on an initiative petition to be used for any purpose other than qualification of the proposed measure for the ballot.

I certify that I will not knowingly or willfully allow the signatures for this initiative to be used for any purpose other than qualification of the measure for the ballot.

__________________________________________

(Signature)

Dated this _____ day of _______________________, 20__

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