The
County Counsel has prepared the following title and summary
of the chief purpose and points of the proposed measure:
(Must be completed After above
signatures have been obtained)
I,__________________________________,am a
registered voter in the county of Marin, California.
PRINT FULL NAME
My residence address is,_____________________________________.
STREET,
CITY,
STATE,
ZIP CODE
I circulated this section of the petition and saw each of the
appended signatures being written. Each signature on this petition is, to
the best of my information and belief, the genuine signature of the person
whose name it purports to be. All
signatures on this document were obtained between,________________________1996
and ________________________,1996.
Month, Day
Month, Day
I declare under penalty of perjury under the laws of the State of
California that this entire declaration is true and correct. Executed on ___________________,1996 at _____________________ CA.
Month, Day
City, State
Signature
(Full Name) of Circulator
·
Circulator
Instructions: Use ink or ball-point only. All signatures will be Invalid if the Declaration of
Circulator
is not completed and signed! Please
return all petitions By May 20, 1996.
Return To: Lucien F. Remy-PO
Box 142-Fairfax, CA. 94978