Tenn. Code § 6-1-209
Petitions for adoption of this charter shall be in substantially the following form:
PETITION FOR INCORPORATION ELECTION FOR TOWN (CITY) OF ______________, 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 thirty-three and one-third percent (331/3%) 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 Tennessee Code Annotated, title 6, chapters 1-4, and be known by the name and style of the "Town (City) of ______________, Tennessee," all as prescribed in Tennessee Code Annotated, title 6, chapters 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 (1) 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 (4) wards.)
The proposed plan of services is as follows: (Here insert a description of the plan of services as defined in Tennessee Code Annotated, § 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 TENNESSEECOUNTY 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 such person executed it as such person's free act and deed.
____________________
Signature and Seal of Notary Public
My commission expires: ______________
T.C.A. § 6-1-209