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PETITION FOR REFERENDUM

We, the undersigned, being duly qualified and registered electors of the City of Collinsville, Illinois, equaling in number at least 10% of the
number of registered voters in Collinsville, Illinois who have affixed our signatures in our own proper persons to this Petition, hereby
PETITION, pursuant to Article 7, Section 6(b) of the Illinois Constitution and Section 28-7 of the Illinois Election Code, that there be
submitted to the electors of the City of Collinsville, for approval by a majority of the electors in the city voting on the question, at the
General Election to be held on April 5, 2010 in the manner provided by law, the following proposition:

SHALL THE CITY OF COLLINSVILLE, ILLINOIS CEASE TO

BE A HOME RULE UNIT? YES [ ] NO [ ]

SIGNATURE ADDRESS VILLAGE COUNTY STATE

1 Collinsville St. Clair Illinois

2 Collinsville St. Clair Illinois

3 Collinsville St. Clair Illinois

4 Collinsville St. Clair Illinois

5 Collinsville St. Clair Illinois

6 Collinsville St. Clair Illinois

7 Collinsville St. Clair Illinois

8 Collinsville St. Clair Illinois

9 Collinsville St. Clair Illinois

10 Collinsville St. Clair Illinois

11 Collinsville St. Clair Illinois

12 Collinsville St. Clair Illinois

13 Collinsville St. Clair Illinois

14 Collinsville St. Clair Illinois

15 Collinsville St. Clair Illinois

STATE OF ILLINOIS )
) SS
COUNTY OF ST. CLAIR )

I, _____________________________________, do hereby certify that I am upwards of the age of 18 years, that I

reside at ___________________________ in the City of Collinsville, County of St. Clair, and State of Illinois, and
that the signatures on this sheet were signed in my presence, and are genuine, and that to the best of my knowledge
and belief the persons so signing were, at the time of signing the said Petition for Referendum, registered voters of
the City of Collinsville and that their respective residences are correctly stated as above set forth.

____________________________________
CIRCULATOR’S SIGNATURE
Subscribed and sworn to before me this _____ day of , 2010.
_______________________________
NOTARY PUBLIC My commission expires , 200 .
Sheet # (SEAL)