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PETITION
TO THE LEGISLATIVE COUNCIL OF VICTORIA
The Petition of certain citizens of the State of Victoria draws to the attention of the Legislative Council (replace this text with the
circumstances of the case)
The Petitioners therefore request that (replace this text with the action or remedy sought from the Legislative Council)
Name
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.

Address

Town/Suburb

Postcode

Signature