Format- Front Side of Petition

(1) Heading. The petition form prepared by the Secretary of the Commonwealth may contain a heading. The heading may include, but is not limited to, the following: (a) the words, “The Commonwealth of Massachusetts”; (b) identification of the type of state ballot question petition (i.e., initiative petition for a law); (c) language identifying the authority for the petition (i.e., “Under Article XLVIII of the Amendments to the Constitution of the Commonwealth”); (d) the State Coat of Arms. (2) Filing Deadlines Box. The petition form prepared by the Secretary of the Commonwealth shall include a box containing the applicable filing deadlines, including both: (a) the last day and hour for filing with the local election officials for certification; and (b) the last day and hour for filingwiththe Secretary of the Commonwealth’s Elections Division. (3) Summary. The petition form shall include the summary of the proposed measure, as written by the Attorney General; the summary shall appear above the First Ten Signers and the Signature Gathering Box. (4) First Ten Signers. (a) The petition form shall include a box containing the names and addresses of the first ten signers of the petition, as required by the Massachusetts Constitution, and the box shall be identified as such. The names and addresses of the first ten signers, as designated in writing by the filer of the petition at the time of filing, shall appear as they are on the certificates of voter registration provided at the time of filing; however: 1. Abbreviations of street designations will not be used, i.e. street and road shall not be abbreviated. 2. Where an apartment or unit number is given on the voter registration certificate, it will be included on the petition in the following format: Name XX Street Name, # X City or Town (b) Accompanying the names and addresses of the first ten signers shall be the following statement of certification: “These names have been certified as names of registered voters in their places of residence. Originalpetitionwas filed on (date).” Below such statement shall appear the signature of the Secretary of the Commonwealth of Massachusetts. (5) Registrar Use Only Box. The petition form prepared by the Secretary of the Commonwealth may include a box for registrar use only. If included on the petition form, Registrars of Voters must utilize this box to comply with 950 CMR 55.02(1), and must mark the date and time the petitions are received in this box. Registrars of Voters may also place in this box information they deem necessary, including, but not limited to, the following: (a) the name of the person submitting petitions; (b) the telephone number of the person submitting petitions; and (c) the number of petitions received. (6) Circulator Information Box. The petition form prepared by the Secretary of the Commonwealth may contain additional printed circulator information, upon written request of the first ten signers of the petition. (a) Such request must be in writing and received at the time the petition is filed with the Secretary of the Commonwealth, and: 1. The first ten signers shall be designated as “SPONSORS OF THIS PETITION.” 2. The first ten signers may choose either of the following messages to accompany the above designation: a. MAY BE CONTACTED AT; or b. REQUEST THAT YOU RETURN THIS PETITION TO. 3. Such circulator information may include an address and telephone number. 4. The heading for such address and telephone number shall reflect the letter of the petition as assigned by the Secretary of the Commonwealth pursuant to 950 CMR 48.04(10) (i.e. “Petition X”). 48.04: continued 5. Sample of format for circulator information: SPONSORS OF THIS PETITION MAY BE CONTACTED AT PETITION X X STREET NAME CITY/TOWN, MA XXXXX (XXX) XXX-XXXX (7) Circulator and Signer Information Box. The petition form prepared by the Secretary of the Commonwealth may include a box for instructions to circulators and signers. These instructions given by the Secretary of the Commonwealth may include, but are not limited to, the following: (a) DO NOT ALTER THIS PETITION IN ANY WAY. Additional markings on this petition will disqualify any signatures on this petition. (b) For your signature to be valid, you must be a registered voter in the city or town named below and your signature should be written substantially as registered. Do not sign the same petition more than once. (c) If you are prevented by physical disability from writing, you may authorize some person to write your name and residence in your presence. (8) Signature Gathering Box. (a) The petition form prepared by the Secretary of the Commonwealth shall include a box for gathering signatures. 1. On the left side of the box shall be a consecutively numbered column. At the top of the column shall be the words “REGISTRAR USE.” 2. The next column shall be designated for the signatures of registered voters, and shall be appropriately labeled. 3. The next column shall be designated for the addresses of those registered voters who signed in the previous column, and shall be appropriately labeled. 4. The last two columns shall be used for the ward and precinct of the registered voter, respectively, and such columns shall be appropriately labeled. (b) The Signature Gathering Box shall continue on the back side of the petition form. The numbering shall continue in consecutive order from the front side of the petition form. (c) The number of signature lines contained on the petition form shall be determined by the length of the summary. (9) Name of City or Town Box. The petition form prepared by the Secretary of the Commonwealth may include boxes for persons soliciting signatures to insert the name of a city or town. Such boxes shall be appropriatelylabeled, i.e. “ONLY REGISTERED VOTERS OF ________________ MAY SIGN THIS SHEET.” (10) Petition Designation. Each petition filed with the Secretary of the Commonwealth shall be assigned a designation determined by order of submission and this designation may be placed on the petition form so as to allow for easy identification (e.g. A, B, C). Petition forms for supplemental signatures prepared by the Secretary of the Commonwealth shall be assigned a designation based on the original order of submission (e.g. AA, BB, CC). (11) Circulator Petition Sheet Number Box. The petition form prepared by the Secretary of the Commonwealth may include a CirculatorPetitionSheetNumberBoxto be printed on the petition itself, upon written request of the first ten signers of the petition. (a) Such request to have a Circulator Petition Sheet Number Box printed on the petition blank must be in writing and received at the time the petition is filed with the Secretary of the Commonwealth. (b) The numbering placed in the Circulator Petition Sheet Number Box may contain only numbers and the use of a connector—for example: 1 of 20, or 1/20, or just consecutive numbers. The Circulator Petition Sheet Number Box may not contain any letters other than those in the connector—for example, no initials may be used.