Information Page For Statewide Referendum Petition Form
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2INFORMATION PAGE FOR STATEWIDE REFERENDUM PETITION
Must be submitted with each petition filing
MARYLAND SECRETARY OF STATE
Jeffrey Building, 16 Frances Street
Annapolis, Maryland 21401
(410) 974-5521
Petition Purpose
Date Filed ________________________
Bill Number __________ Bill Short Title ___________________________________________
Description of Bill _____________________________________________________________
______________________________________________________________________________
NOTE: If a summary of the bill or part of the bill being referred is printed on the back of the petition signature
page, a copy of the Attorney General's approval of that summary must be included.
Advance Determination
Was petition submitted to the State Board of Elections for advance sufficiency
determination?
_____ Yes
_____ No
If yes, include a copy of sufficiency notice with filing.
Sponsor Identification
Sponsor’s Name________________________________________________________________
Mailing Address _______________________________________________________________
Telephone # ___________________________ Fax # __________________________________
Email: ________________________________
Designated Representative Information
NOTE: If Sponsor is an organization, the following information must be given for the individual
designated by the Sponsor to receive notices in connection with the Petition.
Name_________________________________________________________________________
Mailing Address ______________________________________________________________
Telephone # ___________________________ Fax # _________________________________
Email: ________________________________
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