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<br />Prospective Petition for Local Measure <br /> <br />S.EL 370 <br /> <br />rev 7/Q5: ORS 250,045, <br />250,285,250.285,255.135 <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 co un tylcityl district <br /> <br />please type or print legibly in black ink <br /> <br />Olnitiative 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 />1';9n..u" <br /> <br />residence address <br /> <br />mailing address if different <br /> <br />emaH address andlor website <br /> <br />day phone number <br /> <br />sponsoring organization if any <br /> <br />name print <br /> <br />I ';9n.'u," <br /> <br />residence address <br /> <br />mailing address if different <br /> <br />emaH address andlor web site <br /> <br />day phone number <br /> <br />, sponsoring organization if any <br /> <br />name print <br /> <br />I ';9n.,"" <br /> <br />residence address <br /> <br />mailing address if differerr~ <br /> <br />.emaH address andlor website <br /> <br />day phone number <br /> <br />spo.nsoring organizatior:t if any <br /> <br />please read the instructions for' circulators and sig~ers on the reverse side <br /> <br />SEL 370 <br />