Schedule 3
FORM OF WRIT FOR A REFERENDUM
STATE OF VICTORIA
To the Victorian Electoral Commission
I request that you cause a Bill entitled [here set out the Short Title of the Bill and add "a copy of which is attached" or "a statement of which is attached"] to be submitted, according to law to the electors of Victoria.
I appoint the following dates for the purposes of the referendum.
1. For the close of the roll the day of 20 .
2. For the taking of votes of the electors the day of 20 .
3. For the return of the writ on or before the day of 20 .
[here insert the Governor's title] at [here insert place] the day of 20 .
Signature
Sch. 4 inserted by No. 2/2003 s. 22.