PETITION FOR FORMATION OF UTILITY LOCAL IMPROVEMENT DISTRICT

The undersigned property owners or their legally authorized representative, do hereby
petition Whatcom County Water District No. 4 (the "District") to initiate a Utility Local
Improvement District ("ULID") for the improvement of certain property by the construction of a
community sanitary sewer system, which is more fully described on the attachment to this
petition (Attachment A). The improvements will be done in accordance with approved plans and specifications of the District.

The territory to be included within the ULID is legally described on the attachment to this
petition (Attachment B). As shown on the records of the Whatcom County Assessor, the
petitioners own at least 51% of the property within the proposed ULID.

By signing this petition, we, the undersigned property owners, are NOT obligated to any
financial commitment of any kind. Any financial commitments will come later after the public
process as outlined in Chapter 57.16.060 in the WA State RCW's.

PETITION FILED with the Secretary of the Board of the Board of Commissioners of the _________________ Whatcom County Water District No. 4 this ________day of____________, 20_____.

(NOTE: If more than person is on title to an individual property, we recommend signatures by all parties; signatures do not have to be notarized.]

Print Name(s)	Print Street Address
1)__________________________________________________________________
Signature(s)__________________________________________________________
2)__________________________________________________________________
Signature(s)__________________________________________________________
3)__________________________________________________________________
Signature(s)__________________________________________________________
4)__________________________________________________________________
Signature(s)__________________________________________________________