Num 146. 3741

SUPPLEMENT
TO THE
NEW ZEALAND GAZETTE
OF
THURSDAY, DECEMBER 11, 1919.
Published by Authority.

WELLINGTON, MONDAY, DECEMBER 15, 1919.

Prescribing Forms of Declaration by Persons not registered as Electors.

LIVERPOOL, Governor-General.
ORDER IN COUNCIL.
At the Government Buildings at Wellington, this fifteenth day of December, 1919.

Present:
THE HON. SIR WILLIAM FRASER, KT., PRESIDING IN COUNCIL.

I N pursuance and in exercise of the powers and authority conferred upon him by the New Zealand Expeditionary Forces Voting and Electoral Rights Amendment Act, 1919, His Excellency the Governor-General of the Dominion of New Zealand, acting by and with the advice and consent of the Executive Council of the said Dominion, doth hereby prescribe the forms in the Schedule hereto as the respective forms of declaration to be made under section thirteen of the said Act by persons not being registered as electors of any district.

SCHEDULE.

DECLARATION BY PERSON APPLYING TO VOTE WHOSE NAME IS RULED OUT ON CERTIFIED COPY OF THE ROLL.

I, , do hereby declare as follows:—
(1.) I am the person whose name appears on the certified copy of the Electoral Roll as , and which name is ruled out thereon.
(2.) I was legally qualified to be enrolled as an elector for the aforesaid district, and am still so qualified.
(3.) I am not registered on any other electoral roll, and I am not aware of the circumstances that have caused my name to be so ruled out.
(4.) I have not already voted at this election.

Signature of elector:
Full postal address:
Occupation:

Declared before me this day of , 19 .
............................................
Deputy Returning Officer.
Polling-place.

DECLARATION BY PERSON APPLYING TO VOTE WHOSE NAME DOES NOT APPEAR ON CERTIFIED COPY OF THE ROLL.

I, , do hereby declare as follows:—
(1.) I was enrolled as an elector of the Electoral District and duly voted at the last election for the said district, and my name does not appear on the certified copy of the roll for the present election.
(2.) I was legally qualified to be enrolled as an elector for the aforesaid district, and am still so qualified.
(3.) I am not registered on any other electoral roll, and I am not aware of the circumstances that have caused my name to be omitted from the roll.
(4.) I have not already voted at this election.

Signature of elector:
Full postal address:
Occupation:

Declared before me this day of , 19 .
............................................
Deputy Returning Officer.
Polling-place.

DECLARATION BY PERSON APPLYING TO VOTE WHOSE NAME HAS BEEN OMITTED FROM THE CERTIFIED COPY OF THE ROLL.

I, , do hereby declare as follows:—
(1.) That I made a claim for enrolment as an elector of the Electoral District, and was informed by the Registrar of Electors that my name had been entered on the electoral roll of the district.
(2.) That I was legally qualified to be enrolled as an elector for the aforesaid district, and am still so qualified.

Signature of elector:
Full residential address:
Occupation:

Declared before me this day of , 19 .
............................................
Deputy Returning Officer.
Polling-place.

F. W. FURBY,
Acting Clerk of the Executive Council.