This legislation has been repealed.
(Section 22 (2))
Iofdesire to vote in and for the (a)ward of the proposed united area of (b)
I, do solemnly and sincerely declare that:
(1) I am the person named in the local government roll for the area of (c)as prepared under the Local Government Act 1919 , and in force at the date of this my declaration, my name being numbered on that roll as in the margin hereto,
(2) My qualification for enrolment as set out in such roll is in respect of land or a place of living which is situated within the said ward.
(3) I have not already voted in the said ward of the said united area at this election.
Made and subscribed before methisday of194.
(a) insert name of ward
(b) insert name of proposed united area
(c) insert name of area for which claimant is enrolled