I/we wish to support the Council Tax Campaign by submitting my/our name(s) and address details for the petition.

BLOCK CAPITALS PLEASE

NAME/S:

Mr. /Mrs. / Ms. / Miss…………………………………………….

…………………………………………………………………….

ADDRESS:

………………………………………………………………………

………………………………………………………………………

………………………………………………………………………

………………………………………………………………………

Signature/s………………………………………………………..

…………………………………………………………………….

Please print this form page, fill in your name and address details and POST to

The Chairman,
9 St Valentines Way,
Beacon Park,
Skegness.
Lincs.

Thank you