PETITION TO REDRESS GRIEVANCE

TITLE:
To: (specific government agency or specific officeholder) SOURCE ELEMENTS Of THIS SPECIFIC GRIEVANCE: (document top half dozen causes of Citizen dissatisfaction - - keep
each statement to less than 60 words) 1 2 3 4 5 6

THEREFORE. IN ACCORD WITH OUR 1st AMENDMENT CONSTITUTIONAL RIGHT, THE FOLLOWING CORRECTIVE ACTIONS ARE SOUGHT FROM YOU BY THE CITIZENS SUBMITTING THIS FORMAL PETITION: (document 3-4
specific actions requested that will rectify this 1st Amendment grievance - - keep each statement to less than 60 words) 1 2 3 4

SIGNATURES / NAME City of OF Residenc U.S.A. e CITIZE N

submitted on this date: STat CONG. Legis. e DISTRIC distric T t