INITIATIVE PETITION
T
he object of this petition is to: (See reverse side for actual text of measure)
T
o the Honorable Robert Evnen, Secretary of State for the State of Nebraska:
We, the undersigned residents of the State of Nebraska and the county of ___________________________________, respectfully demand that the following proposed amendment
to the Constitution of Nebraska shall be referred to the registered voters of the state for their approval or rejection at the general election to be held on the 5
th
day of November 2024, and
each for himself or herself says: I have personally signed this petition on the date opposite my name; I am a registered voter of the State of Nebraska and county of ___________________
and am qualified to sign this petition or I will be so registered and qualified on or before the date on which this petition is required to be filed with the Secretary of State; and my printed
name, date of birth, street and number or voting precinct, and city, village, or post office address are correctly written after my signature.
WARNING TO PETITION SIGNERS—VIOLATION OF ANY OF THE FOLLOWING PROVISIONS OF LAW MAY RESULT IN THE FILING OF CRIMINAL
CHARGES: Any person who signs any name other than his or her own to any petition or who is not qualified to sign the petition shall be guilty of a Class I misdemeanor.
Any person who falsely swears to a circulator’s affidavit on a petition, who accepts money or other things of value for signing a petition, or who offers money or other things
of value in exchange for a signature upon any petition shall be guilty of a Class IV felony.
__________________________________________________, (name of circulator) being first duly sworn, deposes and says that he or she is the circulator
of this petition containing ______ signatures, that he or she is at least eighteen years of age, that each person whose name appears on the petition personally
signed the petition in the presence of the affiant, that the date to the left of each signature is the correct date on which the signature was affixed to the
petition and that the date was personally affixed by the person signing such petition, that the affiant believes that each signer has written his or her
name, street and number or voting precinct, and city, village, or post office address correctly, that the affiant believes that each signer was qualified to sign the petition, and that the affiant stated to each
signer the object of the petition as printed on the petition before he or she affixed his or her signature to the petition.
___________________________________________________Circulator’s Signature
___________________________________________________Address
___________________________________________________City, State, Zip
Subscribed and sworn to before me, a notary public, this ______ day of ____________ , 20 ___ at _____________________, Nebraska.
(Seal)
___________________
_____________________________ Notary Public’s Signature
DATE
(mm/dd/yy)
SIGNATURE
PRINTED NAME
DATE OF
BIRTH
ADDRESS
(Street Number & Name, City or Village, Zip Code)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
For Secretary of State Use Only
STATE OF NEBRASKA )
) ss
COUNTY OF ________________ )
Amend the Nebraska Constitution to provide all persons the fundamental right to abortion without
interference from the state or its political subdivisions until fetal viability, which is the point in pregnancy
when, in the professional judgment of the patient's health care practitioner, there is a significant likelihood
of the fetus' sustained survival outside the uterus without the application of extraordinar
y medical
measures; or when needed to protect the life or health of the pregnant patient.
(City or village of notarial act.)
SAMPLE
Proposed Constitutional Amendment Language:
Article I of the Nebraska Constitution shall be amended by adding a new section 31 as shown:
All persons shall have a fundamental right to abortion until fetal viability, or when needed to protect the
life or health of the pregnant patient, without interference from the state or its political subdivisions. Fetal
viability means the point in pregnancy when, in the professional judgment of the patient's treating health care
practitioner, there is a significant likelihood of the fetus' sustained survival outside the uterus without the
application of extraordinary medical measures.
SAMPLE