Appendix A-1. Committee Affidavit

State of Minnesota )
) ss
County of ________ )

We certify that the undersigned are all residents of the city of Minnetonka who are eligible voters and have formed a committee for the purpose of circulating a petition to:

[Chose one:]

initiate an ordinance regarding _____________________________________ a copy of which is attached.

refer to the people Ordinance No. ____________, adopted on ____________, by the Minnetonka city council regarding _________________________________________________________________________

Attached is a copy of the proposed petition. The names and addresses of the committee members are (a minimum of five is required):

Name Address

1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
4. ________________________________________________________________________
5. ________________________________________________________________________
6. ________________________________________________________________________
7. ________________________________________________________________________
8. ________________________________________________________________________
9. ________________________________________________________________________
10. ________________________________________________________________________

Signatures of committee members (each of which must be notarized):

____________________________ Signed and sworn to before me on ______________ by _____________

____________________________ Signed and sworn to before me on ______________ by _____________

____________________________ Signed and sworn to before me on ______________ by _____________

____________________________ Signed and sworn to before me on ______________ by _____________

____________________________ Signed and sworn to before me on ______________ by _____________