§ 6-1-209 SAMPLE PETITION FOR ADOPTION.
   Petitions for adoption of this charter shall be in substantially the following form:
 
PETITION FOR INCORPORATION ELECTION FOR TOWN (CITY)                                                                                             , TENNESSEE TO: The County Election Commission,                                   County, Tennessee
We the undersigned, being registered voters and residents of the territory herein proposed for incorporation, and being in number in excess of 33-1/3% of the registered voters of the herein described territory hereby request the county election commission to hold an election on the question of whether or not the herein described territory shall be incorporated under the terms of Tenn. Code Ann. Title 6, Ch. 1-4, and be known by the name and style of the “Town (City) of                                                                , Tennessee”, all as prescribed in Tenn. Code Ann. Title 6, Chs. 1-4.
The territory in question, being part of the                                     , Civil District(s) of                                         County, Tennessee is further described as: (here insert a description of boundaries with references to tax maps)                                                                            
The wards of the Town (City) shall be as follows: (here insert a description of wards, and if there is only one ward state that the boundaries are as described above)                                                       
Wards that will carry an initial two-year term: (for those municipalities incorporating with more than four wards)
The proposed plan of services is as follows: (here insert a description of the Plan of Services, as defined in Tenn. Code Ann. § 6-1-203)
 
 
PETITIONERS’ SIGNATURES
                                                                                                                                
Name            Residence Address            Date
(List name and residence as on registration records)
Certificate
I,                                                                                          , hereby certify that I, personally, solicited the signatures of the persons appearing on this page and that they, in fact, signed their names to this petition in my presence.
Name                                                                                                                  
Address                                                                                                               
Date                                                                                                                    
STATE OF TENNESSEE
COUNTY OF                                                                      
On this                     day of                                          , 20           , before me personally appeared                                       , to me known to be the person described in, and who executed, the foregoing instrument, and acknowledged that he (she) executed it as his (her) free act and deed.
Signature and Seal of Notary Public                                                                            
My commission expires:                                                                                            
 
[Acts 1991, ch. 154, § 1; Acts 1993, ch. 320, § 4]