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(Section 112 (5) of the Act)

Referendum Ballot

The Board of Education of School District No. ........ (.................) seeks approval to raise funds in the ............ calendar year through local residential taxation for expenditures in the next school year in addition to those provided for by the operating grant to this school district. Please place an "X" in the appropriate box signifying that you approve or do not approve of each proposed expenditure.

1. New, and enhanced, programs Description of programs __________________________________ __________________________________
Costs for additional staffing	$ ................	|	Tax consequences per
Costs for additional services and supplies	$ ................	|	$10 000 of assessed property value
TOTAL COSTS $ ...................		|	$ ...................
	I approve of this expenditure                 I do not approve of this expenditure

2. Additional activities for students Description of activities __________________________________ __________________________________
Costs for additional staffing	$ ................	|	Tax consequences per
Costs for additional services and supplies	$ ................	|	$10 000 of assessed property value
TOTAL COSTS $ ...................		|	$ ...................
	I approve of this expenditure                 I do not approve of this expenditure

I approve of this expenditure                 I do not approve of this expenditure

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