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HomeMy WebLinkAboutAdditional Signatures - Petitions Petition Submission SEL 339 ev. 01/16 Initiative, Referendum, Recall, Political Party Formation OAR 165-010-0005, 165-0 14-0005 4 This form must be completed and filed with any submission of s iatures. When the submission completes the petition all chief petitioners must sign the same form. At least one chief petitior Or the chief sponsor must submit signatures for verification. State Initiative Petition Only An authorized agent may complex-. this form and submit sponsorship signatures or a monthly submission. If the initiative has multiple chief petitioners only one chief petitioner is required to sign for a monthly submission. Filing Officer ❑ State ❑ County For both county and district petitions. City Type of Petition [Q Initiative ❑ Referendum ❑ Recall ❑ Political Party Formation Petition Information Petition Title or Number 1, c, \ 60 Type of Filing Number of Signatures Submitted ❑ Sponsorship Submission State Initiative Petition ❑ Monthly Submission State Initiative Petition ❑ Other Submission State Initiative Petition 4 ['Completed Petition Submission Authorized Agent Certification only allowed for monthly submittal of signatures for state initiative petitions. 4 By signing this document, I hereby state that all information on the form is true and correct to the best of my knowledge. Name Contact Phone Email Address Signature Date Signed Chief Petitioner or Chief Sponsor Certification To complete a petition all chief petitioners must sign the same form. 4 By signing this document, I hereby state that all information on the form is true and correct to the best of my knowledge and if marked completed petition I understand the petition cannot be withdrawn and request that the appropriate elections official conduct signature verification. Additionally if the petition is an initiative or referendum I attest that no circulators were compensated money or other valuable consideration based on the number of signatures obtained by the circulator. Name Contact Phone Email Address ~kv.-~, ~-~.~~i~~-~.;v.~i✓tcGit ~j.,L' T~-~.,~~,c~sv~~~~:.~'?~-~+`~=C~-~wtr~~~;c~: Signature Date Signed SIC Name Contact Phone Email Address Signature Date Signed t Name Contact Phone Email Addre;~~. 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