Fillable Citizens-petition - Citizen Petiton Form_Revised

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Citizens-petition - Citizen Petiton Form_Revised

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DATE
ASHBURNHAM TOWN MEETING - CITIZEN’S PETITION
Purpos
e:__________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Proposed Article: ___________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
SIGNERS’ STATEMENT We are qualified voters of the Commonwealth of Massachusetts and of the Town of Ashburnham.
INSTRUCTIONS TO SIGNERS:
Your signature should be written as substantially as registered. If you are prevented, by physical disability, from writing you may
authorize some person to write your name and residence in your presence.
C
h
e
c
k
Signatures to be made in person with name
substantially as registered (except in case of
physical disability as stated above)
Now Registered At
(Street and Number)
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WARNING – criminal penalty for unlawfully signing, altering, defacing, mutilating, destroying or suppressing this petition paper: fine of
up to $1,000 or imprisonment for up to one year.
Instructions to Registrars
Check thus against the name of qualified voter to be certified. For names not
certified, use the codes opposite.
N no such registered voter at that address.
S
unable to identify signature or address as that of voter because of form of
signature or address, or illegible.
W wrong district or community.
T already signed this petition.
CERTIFICAT
ION OF SIGNATURES
We certify that ( ) ____________________ signatures checked thus
are names of voters of the Town of Ashburnham and are qualified to
sign!this petition.
(at least three Registrars= names must be signed or stamped below)
Registrars of Voters of the Town of Cohasset
TOWN OF ASHBURNHAM: CITIZEN PETITION WARRANT ARTICLE FORM
Please use this form when collecting signatures for a Citizen’s Petition Warrant Article for either Annual or a
Special Town Meeting. Use additional sheets as necessary, but please be sure to include the proposed language of
the Warrant Article and the purpose of the proposed Article on each sheet.
Annual Town Meeting requires a minimum of ten (10) valid signatures. Special Town Meetings require a
minimum of one hundred (100) valid signatures
In addition to including the specific language of the Article, please describe the purpose of the Article, including
whether or not it has any financial implications, and the projected amount of those financial impacts.
The first person named on the petition is considered the “Petitioner,” and will be considered the sponsor of the
Article. The Petitioner may be asked to appear before the Advisory Committee and the Board of Selectmen
to explain the purpose of the proposed Article prior to Town Meeting. In addition, the Petitioner will
be designated the primary speaker in support of the Article at Town Meeting unless someone else is noted
below.
The deadline for submission of Citizen’s Petitions is announced by the Select Board usually around a month or
more before the date the Town Meeting - please check with the Town Clerk’s Office to confirm the date for each
Town Meeting.
Petition Contact Information
PETITIONER Name: ____________________________________________________________________
Address: _______________________________________________________________________________
E-Mail address: _________________________________________________________________________
Telephone Number: ___________________
SPEAKER Name (if different):_____________________________________________________________
Address: _______________________________________________________________________________
E-Mail address: _________________________________________________________________________
Telephone Number: ___________________
Please contact either the Town Clerk’s office at (978) 827-4100, x114 or the Selectmen’s Office (978)
827-4100, x109 with any questions, or visit the Town website at www.Ashburnham-ma.gov.
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Completed 11 July 2020

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