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<br />Prospective Petition for Local Measure <br /> <br />SEL 370 <br /> <br />rev 7/05: ORS 250,045, <br />250,265,250,265,255,135 <br /> <br />County: <br /> <br />City: <br /> <br />District: <br /> <br />To the County Elections Filing Officer/City Recorder (Auditor), <br />We, the undersigned, request the circle one district attorney/city attorney prepare a ballot title for the attached proposed <br /> <br />measure to be submitted to the people of name of county /city/district <br /> <br />please type or print legibly in black ink <br /> <br />o Initiative Petition <br /> <br />o Referendum Petition <br /> <br />designating chief petitioners <br />Every petition must designate not more than three persons as chief petitioners, setting forth the name, <br />residence address and title (if officer of sponsoring organization) of each. Please carefully read the instructions for <br />circulators and signers on the back of this form. <br /> <br />name print <br /> <br />I s;gn,tu," <br /> <br />residence address <br /> <br />mailing address if different <br /> <br />email address and/or website <br /> <br />day phone number <br /> <br />sponsoring organization if any <br /> <br />name print <br /> <br />I s;gn,"', <br /> <br />residence address <br /> <br />mailing address if different <br /> <br />email address and/or website <br /> <br />day phone number <br /> <br />sponsoring organization if any <br /> <br />name print <br /> <br />I s;gn,"', <br /> <br />residence address <br /> <br />mailing address if different <br /> <br />email address and/or web site <br /> <br />day phone number <br /> <br />sponsoring organization if any <br /> <br />please read the instructions for circulators and signers on the reverse side <br /> <br />SEL 370 <br />