Resources: Public Library District Toolkit: Strategies to Assure your Library’s Legal and Financial Stability: Sample Petition Chapter 414

Sample Petition Chapter 414

(IMPORTANT: Check with your local Board of Elections before using this form)

Petition to Vote to Fund the Clinton Community Library

I, the undersigned, do hereby state that I am a registered voter of the Town of Clinton, that my present place of residence is truly stated below my signature hereto, and that I do hereby petition that the following question be placed upon the ballot and voted on at the next general election of the Town of Clinton:

SHALL THE ANNUAL CONTRIBUTION OF THE TOWN OF CLINTON FOR THE OPERATING BUDGET OF THE CLINTON COMMUNITY LIBRARY BE AT ONE HUNDRED FIFTEEN THOUSAND DOLLARS ($115,000.00) ANNUALLY.

Date:______Signature: _____________________________Print: ___________________________________________
Address: __________________________________________Town: Clinton County: Dutchess

I, (Print Name) ____________________________, state that I am a duly qualified voter of the State of New York. I now reside at (residence address) _______________________________________________________________________. Each of the persons that have signed this petition sheet containing ______ signatures have signed their names in my presence on the dates indicated above and identified themselves to be the same person who signed the sheet. I understand that this statement will be accepted for all purposes as the equivalent of an affidavit, and if it contains a materially false statement, shall subject me to the penalties of perjury.

Date: ________________ Signature of Witness: __________________________________ Page _____