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<br />County/City District Initiative Petition or <br />County/City/District Referendum Petition Sample Cover Sheet <br /> <br />rev 7/05 <br /> <br />A Signature Sheet must be copied on the reverse side of each Cover Sheet. The ballot title must appear the same as the <br />ballot title filed by the District/City Attorney or approved by the Circuit Court. <br />BALLOT TITLE <br />Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Praesent accumsan est. Vivamus dignissim. Nulla vitae wisi. <br />Vestibulum ac mauris. Sed interdum euismod quam. <br />CAPTION: mauris tempor, lectus eu venenatis gravida, nisi mi accumsan pede, in tempor elit ligula nec mi. Vivamus <br />rutrum bibendum diam. Proin dignissim placerat massa. Morbi pellentesque. Nullam pede. <br />QUESTION: cras id magna sit amet augue consectetuer euismod. In placerat. Aenean sit amet arcu vitae est eleifend <br />consectetuer. Donec gravida metus vel arcu. Vestibulum gravida malesuada eros. Suspendisse <br />SUMMARY: Proin volutpat, felis sit amet tincidunt ullamcorper, justo tellus condimentum tortor, quis molestie lacus <br />risus vitae odio. Nunc est lectus, eleifend et, feugiat quis, pulvinar in, metus. Nulla sit amet felis nec diam ultricies semper. <br />Donec wisi lectus, congue in, bibendum at, vestibulum ut, quam. Maecenas facilisis metus quis Iibero. <br />Text of Initiative or Referendum <br />A chief petitioner may, but is not required to, place the text of an initiative or referendum petition here. Replace this text and <br />the text below with the actual text ofthe initiative or referendum. Ifthe text is not printed on the cover sheet, the person <br />obtaining signatures on the petition must carry at least one full and correct copy ofthe measure to be initiated or referred <br />and must allow the text to be reviewed upon request (ORS 250.045). <br />Cursus Non Posuere: <br />(X) Sit amet, iaculis vel, lectus. Proin placerat. Donec tempor malesuada enim. Nunc aliquam pede ut neque. Proin sit <br />amet eros nec ante hendrerit convallis. Vestibulum vulputate sodales arcu. Praesent condimentum turpis sit amet sem. <br />(X) Pellentesque feugiat ullamcorper odio. Nunc ut magna. Suspendisse tempor tortor. Morbi vitae leo at diam conse- <br />quat rhoncus. Curabitur pulvinar sem a sapien. Cras sagittis. Suspendisse potenti. Ut orci velit, tempus vel, semper tin <br />Idunt: <br />(X) Consectetuer sit amet, sapien. Curabitur laoreet tincidunt augue. Curabitur quis elit. Nam et sem eget turpis ultricies <br />sodales. Donec rutrum erat vel ligula. <br />Chief Petitioners <br /> <br />name <br />residence address <br />city, state, zip code <br />Instructions for Circulators <br />-+Only active registered voters ofthe county, city or district may sign a petition. <br />-+AII signers on anyone signature sheet must be active registered voters ofthe same county. <br />-+It is advisable to have signers use a pen for signing petitions or for certifying petitions. <br />-+Only one circulator may collect signatures on anyone sheet of a petition. <br />-+Each circulator must personally witness all signatures the circulator collects. <br />-+Circulators shall not cause to be circulated a petition knowing it to contain a false signature. <br />-+Circulators shall not knowingly make any false statement to any person who signs it or requests information about it. <br />-+Circulators shall not attempt to obtain the signature of a person knowing that the person is not qualified to sign it. <br />-+Circulators shall not offer money or any thing of value to another person to sign or not sign a petition. <br />-+Circulators shall not sell or offer to sell signature sheets. <br />-+Circulators shall not accept compensation to circulate a petition that is based on the number of signatures obtained. <br /> <br />name <br />residence address <br />city, state, zip code <br /> <br />name <br />residence address <br />city, state, zip code <br /> <br /> <br />Instructions for Signers <br />-+Only active registered voters ofthe county, city or district may sign a petition. Sign your full name, as you did when you <br />registered to vote. <br />-+Please fill in the date on which you signed the petition, your printed name and your residence address in the <br />spaces provided. <br />-+It is advisable to use a pen for signing petitions. <br />-+It is unlawful to sign any person's name other than your own. Do not sign another person's name under any circumstances. <br />-+It is unlawful to sign a petition more than once. <br />-+It is unlawful for a person to knowingly sign a petition when the person is not qualified to sign it. <br />