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PAPELETA OFICIALOFFICIAL BALLOT

MODELO MARTES, 6 DE NOVIEMBRE DE2012TUESDAY, NOVEMBER 6, 2012

CONSULTA PLEBISCITE

SAMPLECONSULTA SOBRE EL ESTATUS POLTICO DE PUERTO RICO

PLEBISCITE ON PUERTO RICO POLITICAL STATUS

Instrucciones:Marque la opcin de su preferencia. La papeleta con ms de una (1)opcin marcada en esta seccin noser contabilizada.

Instructions: Mark your option of preference. Those ballots with more than one (1) mark in the section shall not betallied.

Esta usted de acuerdo con mantener la condicion politica territorial actual? Do you agree that Puerto Rico shall continue to have its present form of territorial

status?

S/ Yes ____________________________ No/ No ____________________________Instrucciones:Irrespectivamente de su contestacin a la primera pregunta,

conteste cul de las siguientes opciones no territoriales usted preere.Instructions:Regardless of your selection in the rst question,

please mark which of the following non-territorial option would you prefer.La consulta con ms de una (1) opcin marcada en esta seccin no ser contabilizada.

Those ballots with more than one mark in the Section shall not be tallied.

Estadidad:Preero que Puerto Rico sea unestado de Estados Unidos deAmrica, para que todos losciudadanos americanos residentesen Puerto Rico tengan igualesderechos, benecions y

Independencia:Preero que Puerto Rico sea unanacin soberana y totalmenteindependiente de Estados Unidos yque se requiera al Congreso Federalque promulgue la legislacinnecesaria para iniciar la transicin

Estado Libre AsociadoSoberano

Preero que Puerto Rico adopte unestatus fuera de la ClusulaTerritorial de la Constitucin deEstados Unidos, que reconozca lasoberana del pueblo de Puerto

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responsabilidades que los demsciudadanos de los estados de laUnin, incluyendo derecho a laplena representacin en el congresoy participacin en las eleccionespresidenciales, y que se requiera alCongreso Federal que promulguela legislacin necesaria para iniciarla transicin hacia la estadidad. Siesta de acuerdo, marque aqu:

hacia la nacin independiente dePuerto Rico. Si esta de acuerdo,marque aqu:

Rico. El Estado Libre AsociadoSoberano se basara en unaasociacin poltica libre yvoluntaria, cuyos trminosespeccos se acordaran entreEstados Unidos y Puerto Ricocomo naciones soberanas. Dichoacuerdo dispondra el alcance delos poderes jurisdiccionales que elpueblo de Puerto Rico autoricedejar en manos de Estados Unidosretendra los restantes poderes oautoridades jurisdiccionales. Si estade acuerdo, marque aqu:

Statehood:

Puerto Rico should be admitted asa state of the United States of

America so that all United Statescitizens residing in Puerto Ricomay have rights, benets, and responsibilities equals to thoseenjoyed by all other citizens of thestates of the Union, and be entitled to full representation in Congressand to participate in thePresidential elections, and theUnited State Congress would berequired to pass any necessarylegislation to begin the transitioninto Statehood. If you agree, mark here:

Independence:

Puerto Rico should become asovereign nations, fully independent

from the United States and theUnited States Congress would berequired to pass any necessarylegislation to begin the transitioninto independent nation of Puerto

Rico. If you agree, mark here:

Sovereign Free Associated State:

Puerto Rico should adopt a statusoutside of the Territory clause of the Constitution of the United

States that recognizes thesovereignty of the People of Puerto Rico. The Sovereign Free Associated State would be based on a free and voluntary politicalassociation, the specic terms of which shall be agreed uponbetween the United States and Puerto Rico as sovereign nations.Such agreement would provide thescope of the jurisdictional powersthat the People of Puerto Ricoagree to confer to the United Statesand retain all other jurisdictional

powers and authorities. If youagree, mark here:

____________________________ ____________________________ ____________________________

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