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Illinois Term Limits
To/Against/For: For Constitutional AmendmentNumber of signatures required(target): 250000
X…………..BIND HERE…………X
________________________________, COUNTY
We, the undersigned registered and duly qualified voters of the State of Illinois petition to amend Article IV of the Illinois Constitution by placing the amendment attached hereto before the voters of Illinois at large by referendum at the General Election to be held in this State of Illinois on the second day of the month of November in the year 2010.
DO NOT USE THIS FORM IN AURORA, BLOOMINGTON, CHICAGO,
DANVILLE, EAST ST. LOUIS, GALESBURG, PEORIA, OR ROCKFORD
Shall the voters of Illinois adopt the 2010 Term Limits Amendment which amends Yes []
Article IV, Section 2 of the Illinois Constitution to change Legislative composition
such that Illinois General Assembly members are limited to 2 consecutive terms of office? N0 []
Signature (by signing you are verifying that you have viewed the proposed amendment on back) | Address | City, Village, Town | County |
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Circulator Affidavit
I, _______________________________, being first duly sworn, do hereby certify that I am at least 18 years of age and a citizen of the United States, that I reside at _______________________, in the City, Town or Village of ____________________, County of ____________________, State of Illinois, and that the signatures on the sheet were made in my presence and are genuine and were not made more than 24 months preceding the General Election on November 2, 2010, that the text of the amendment was available for review and that to the best of my knowledge and belief the persons so signing were at the time of signing the petition duly qualified and registered voters of the State of Illinois and that their respective residences are correctly stated as set forth above.
_____________________________
Signature of circulator
Signed and sworn or affirmed to by _____________________ before me, on _________, 20_____.
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(seal of notary) Signature of Notary
Return to P.O. Box 85, Tremont, IL 61568
Sheet No. ______
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