Proposed Improvement Suggestion          

  From:    _____________________                                             

  We are considering an improvement to the _____________________, 
so we would like to know your opinions about it before we implement it.          

Reality: _______________________________________________________________           

Problem: _______________________________________________________________         

Suggestion: _______________________________________________________________                     
Risks: _______________________________________________________________                  

We estimate that the proposed improvement would cost or save you  $  ____ 

If you agree with the improvement, then please enter a "1" here: __          

Please enter how much it would be worth to you here:  $ _________         

If you disagree with the improvement, then please write in your reasons:    
_______________________________________________________________                           
If you disagree, then enter how much the improvement would cost you: $      
 You can edit this sample ballot for an issue that interests you and then send it to Rich Strong. He will then post it for a month on a Current Issues webpage for others to comment about. If there is a significant response, then he will post a notice of voting and tally.

 // StrongWare \\ (s) 
 ALIVESys PETITION / BALLOT  DATE: ___________ 
 From: ___________________________________ 
 Please read and fill in your Ballot/Petition and return it within one week. 
 If you are petitioning, then please skip Lines 1-12; go to Lines 13 and 15. 
 1. The following legislation is being proposed for enactment into law. 
 2. The Preliminary balloting resulted in the following changes: Amounts: 
 _______________________________________________________________
 3. Estimated Change to Federal Budget Model over the life cycle: ___________
 4. Estimated Life Cycle 9 years. Estimated Average Annual Budget:___________
 5. The proposed legislation consists of the following: 
 a. _______________________________________________________________
 b. _______________________________________________________________
 c. _______________________________________________________________
 6. Risk: _________________________________________________________
 7. Benefits to special Groups: ___________________________________
 8. Revenue other than income tax from: ___________________________
 9. Estimated Annual Tax for 15% tax bracket taxpayer: ______¦
10. Representative: Favors Yea?: __ ; 15% bracket tax : ____
11. Do you assign Proxy for favored tax times your factor? (Yes =1, No =0)> __ 
 ( Multiply the 15% amount by your bracket % and then divide by 15.) ¦

12. Do you favor passing the legislation? ( Yea = 1, No = 0 )> _ 
13. Please enter the amount you pledge as tax for legislation.> ____ 
14. If legislation will have a negative impact, enter amount. > _______ 
15. Please enter: a. the reasons for negative impact; or b. your petition: 
 ________________________________________________________________________ 
Please Sign and Date -> _______________________________ Date: __/ ___ / 19__ 
Please enter your PASSWORD: __________ and Credit Card #: ___________________ 
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