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APPENDIX A — SAMPLE PETITION <br />PETITION FOR STREET NAME CHANGE FORM <br />Signature below affirms we request changing the name of our street: <br />from <br />[current street name] <br />[i'.7 <br />[intersecting street] [intersecting street] <br />to the new name: <br />[new name requested] <br />The petitioners ask the City of Roseville to review this request and put it before the City Council for <br />consideration at an upcoming Council meeting. <br />Name <br />Address <br />Signature <br />1 <br />2 <br />3 <br />4 <br />5 <br />6 <br />7 <br />8 <br />9 <br />10 <br />11 <br />12 <br />13 <br />14 <br />15 <br />16 <br />Page 53 of 77 <br />