Petition to require poll
To the Local Government Commission
Organiser of petition: [full name]
[Provide a description of the main features of the final proposal. If the public notice under clause 22(1)(a) of Schedule 3 of the Local Government Act 2002 includes a suggested description of the final proposal for use in a petition to require a poll, it is recommended that you provide that description here.]
| ||Full name||Address (not a post office box)|| ||Signature||Date|
Address for service of organiser of petition:
Contact person: [name and designation, if applicable]
1 Under clause 24(1) of Schedule 3 of the Local Government Act 2002, if a final proposal has been issued under clause 21(1)(a) or (b) of that schedule, affected electors may demand a poll to determine whether or not the final proposal is to proceed and become a reorganisation scheme.
Note to persons signing petition
1 Each person who signs this petition must state, against his or her signature, the person’s name and the address in relation to which he or she qualifies as an affected elector in sufficient detail to enable the person to be identified as an elector. If a person qualifies as a residential elector, the address in respect of which the person is registered is in an affected area must be stated. If a person qualifies as a ratepayer elector, the address in respect of a rating unit in an affected area must be stated.
Note to organiser of petition
A petition to require a poll must be received by the Local Government Commission not later than the close of the 60th working day after the first publication of the notice under clause 22(1)(a) of Schedule 3 of the Local Government Act 2002.