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<br />County/City District Initiative Petition or <br /> <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 /> <br />BALLOT TITLE <br />Lerem ipsum delor sit amet, censectetuer adipiscing elit. Praesent accumsan est. Vivamus dignissim. Nulla vitae wisi. <br />Vestibulum ac mauris. Sed interdum euismed quam. <br />CAPTION: mauris tempor, lectus eu venenatis gravida, nisi mi accumsan pede,ih temper elit ligula nec mi. Vivamus <br />rutrum bibendum diam. Prein dignissim placerat massa. Merbi pellentesque. Nullam pede. <br />QUESTION: cras id magna sit amet augue censectetuer euismed.ln placerat. Aenean sit amet arcu vitae est eleifend <br />cerisectetuer. Donec gravida metus vel arcu. Vestibulum gravida malesuada eres. Suspendisse <br />SUMMARY: Prein velutpat, feJis sit amet tincidunt ullamcerper, juste tellus cendimentum tortor, quis melestie lacus <br />risus vitae edio. Nunc est-Iectus, eleifend et, feugiat quis, pulvinar in, metus. Nulla sit amet felis nec diam ultricies semper. <br />Donec wisi lectus, cengue in, bibendum at, vestibulum ut, quam. Maecenas facilisis metus quis Iibere. <br /> <br />Text of Initiative or Referendum <br />A chief petitioner may, but is not required to, place the text of an initiative er referendum petition here. Replace this text and <br />the text belew with the actual text of the initiative or referendum. Ifthe text is net printed en the cover sheet, the persen <br />obtaining signatures en the petitien must carry at least one full and cerrect copy ef the measure to be initiated or referred <br />and must allew the text to be reviewed upen 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. Prein sit <br />amet eros nec ante hendrerit convallis. Vestibulum vulputate sodalesarcu. Praesent condimentum turpis sit amet sem. <br />(X) Pellentesque feugiat ullamcorper odio. Nunc ut magna. Suspendisse temper terter. Merbi vitae leo at diam conse- <br />quat rhoncus. Curabitur pulvinar sem a sapien. Cras sagittis. Suspendisse potenti. Ut ercivelit, tempus vel, semper tin <br />Idunt: <br />(X) Consectetuer sit amet, sapien. Curabitur laereet tincidunt augue. Curabitur quis elit. Nam et sem eget turpis ultricies <br />sodales. Donec rutrum erat vellig,ula. <br />Chief Petitioners <br /> <br />name <br />residence address <br />city, state, zip code <br />Instructions for Circulators <br />~Only active registered veters efthe county, city or districtmay sign a petitien. <br />~AII signers on anyone signature sheet must be active registered veters ofthe sameceunty. <br />-+It is advisable to have signers use a pen for signing petitions or for certifying petitions. <br />~Only on~ circulator may co.llect signatures en any one sheet ef a petition. <br />~Each circulator must personiilly witness all signatures the circulator collects. <br />~Circulators shall not cause to be circulated a petition knowing it to centain a false signature. <br />~Circulaters shall not knowingly make any false statement to any person who signs it or requests informatien about it. <br />~Circulators shall not attempt to obtain the signature ora person knowing that the person is not qualified to sign it. <br />-+Circulators shall not effer money or anything of value to another person to sign or not sign a petition. <br />~Circulaters shall not sell er efferte sell signature sheets. <br />~Circulaters shall nct accept ccmpensaticn to. circulate a petiticn that is based en the number ef 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 of the ccunty, city or district may sign a petition. Sign ycurfull 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 petiticns. <br />, -+It is unlawful to. sign any person's name other than yeur own. Do not sign another person's name under any circumstances. <br />-+It is unlawful to. sign a petiticn more than cnce. <br />-+It is unlawful for a person to knowingly sign a petiticn when the persen is nct qualified to. sign it. <br />