COUNTY OF SHELBY

PETITION FOR REFERENDUM 
We, the undersigned registered voters of the County of Shelby and State of Tennessee hereby 
petition the Shelby County Election Commission in accordance with the Tennessee Code Annotated 
2­5­151­to place on the ballot a referendum question to amend the Charter of Shelby County to be voted on 
th
in the Election held on the    5    
  day of August , 2010.

                     We request that the following question be placed on the ballot.
TO BE COMPLETED BY PETITIONER
REFERENDUM QUESTION:

Summary: Shall Shelby County Charter be amended by deleting sections: 6.05

Municipalities, 6.07 Annexation, and 6.08 incorporation from Article VI and add a new Article IX
entitled “Annexation, Deannexation, Municipal Boundaries, Incorporation  of Unincorporated
territories, and Municipalities: to provide for the governing of how municipalities in Shelby
County can change their boundaries by annexation and deannexation, and how
unincorporated areas can incorporate. This amendment shall take effect September 30th 2010.

SIGNATURES OF REGISTERED VOTERS
(Must be registered voters of Shelby County)
   
     (Date)                   (Cannot sign for another­No ditto Marks)                     (Address as shown on registration­No P.O. Boxes)

1.________ Sign Name _____________________________________ Street Address _________________________________

Print Name ____________________________________ City, State & Zip _______________________________

2.________ Sign Name _____________________________________ Street Address _________________________________

Print Name ____________________________________ City, State & Zip _______________________________

3.________ Sign Name _____________________________________ Street Address _________________________________

Print Name ____________________________________ City, State & Zip _______________________________

4________ Sign Name _____________________________________ Street Address _________________________________

Print Name ____________________________________ City, State & Zip _______________________________

5.________ Sign Name _____________________________________ Street Address _________________________________

Print Name ____________________________________ City, State & Zip _______________________________

6.________ Sign Name _____________________________________ Street Address _________________________________

Print Name ____________________________________ City, State & Zip _______________________________

7.________ Sign Name _____________________________________ Street Address _________________________________

Print Name ____________________________________ City, State & Zip _______________________________

8.________ Sign Name _____________________________________ Street Address _________________________________

Print Name ____________________________________ City, State & Zip _______________________________

9.________ Sign Name _____________________________________ Street Address _________________________________

Print Name ____________________________________ City, State & Zip _______________________________

10._______ Sign Name _____________________________________ Street Address _________________________________

Print Name ____________________________________ City, State & Zip _______________________________