Whenever any legislator wishes to petition the governor to call a special session of the legislature as provided in section 5 of article 1 of the constitution of the state of Kansas, he shall subscribe the form prescribed in this section, completed by insertion of the name of the governor and the date of the commencement of the special session. Such form shall be sworn to (or affirmed) before an officer authorized to administer oaths. Such form shall be substantially as follows:

State of Kansas, County of __________:

PETITION

To The Honorable ______________, Governor

State Capitol, Topeka, Kansas

You are hereby petitioned to call the Legislature into Special Session, such Special Session to commence at 10:00 a.m., __________, __________, 19__:

______________,    _________________________

Signature          Title and District Number

Subscribed and sworn to before me this __________ day of __________, 19__.

______________ Notary Public

(Seal)

My commission expires: ______________