“REFERENDUM PETITION To the Honorable Secretary of State of the State of Arkansas, or County Clerk, or City Clerk We, the undersigned registered voters of the State of Arkansas, or , entitled ‘An Act County, Arkansas, or City or , Arkansas, (as the case may be) respectfully order by this, our petition, that Act of the General Assembly of the State of Arkansas, approved on the Incorporated Town of No

, 20 (or town) council of the City (or Incorporated Town), or County of , passed by the county quorum court, the city day of ,’ be referred to the people of said state, county, or municipality (as the case may be), to the end that the same may be approved or rejected by the vote of the registered voters of the state, or of said county or municipality (as the case may be) at the biennial (or annual, as the case may be, if a city ordinance) regular general election (or at a special election, as the case may be) to be held on the , entitled, ‘An Ordinance ’ or Ordinance No

, Arkansas, on the day of , 20 day of , 20 ; 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, or County, Arkansas, or City of , Arkansas (as the case may be), 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

, or Incorporated Town of (Here insert popular name and ballot title of referred measure.) REFERRED TO THE PEOPLE OF THE STATE OF ARKANSAS, OR COUNTY, ARKANSAS, OR CITY OF OR INCORPORATED TOWN OF , ARKANSAS (as the case may be): (Here insert full text of referred measure.)”