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To the Honorable Susan Langley, Little Rock City Clerk: We the undersigned, registered voters of the City of Little Rock, Arkansas, respectfully propose the following Initiative Petition and
ordinance be submitted to the people of the City of Little Rock, Arkansas to the end that the same may be adopted, enacted, or rejected by the vote of the registered voters of the City of Little
Valid of
Rock, Arkansas at a regular general election to be held on the 6th day of November, 2018, and each of us for himself or herself says: I have personally signed this petition; I am a registered voter
of the State of Arkansas, and a resident of the City of Little Rock, Arkansas, and my printed name, date of birth, residence, city or town of residence, and date of signing this petition are correctly
written after my signature. The Popular Name is The City of Little Rock, Arkansas, Fair Representation Ordinance of 2018, and the ballot title is attached or fixed hereto. By Date
Voters Registered in County

Date City or County Date

Signature Printed Name of Town of of of
(Street Address)
Birth Residence Residence Signing


State of Arkansas, County of [County where Notary signs] On this day of , 20 , before me, the undersigned Notary Public, personally
appeared _, well known to me (or satisfactorily proven by identification
I, [Canvasser], being sworn, state that each of the foregoing persons signed documents provided) to be the person described in the foregoing Canvasser Affidavit and acknowledged
his or her own name to this sheet of the petition in my presence. To the best of my knowledge and belief, each signature that s/he executed the same in the capacity of a Canvasser for the purpose of fulfilling legal requirements of
is genuine and each signer is a registered voter of the State of Arkansas, in the County listed at the top of the Petition. At all a Canvasser in the State of Arkansas; and that I personally witnessed the signature of the Canvasser.
times during the circulation of this signature sheet, an exact copy of the popular name, ballot title, and text was attached to
this signature sheet. My current residence address is correctly stated below. Signature of Notary:
Signature: Residence: My Commission Expires:
Indicate one: ( ) Paid Canvasser ( ) Volunteer/Unpaid Canvasser Residence County of Notary:_

SOS – PUBLIC For term limits information: 501-590-8260 Return petitions to: Arkansas Term Limits, P.O. Box 242774, Little Rock, AR 72223 [Notary Seal Above]