Document ID: chunk:federal_register_of_legislation:F2006C00692:body:0:p19
Version: federal_register_of_legislation:F2006C00692
Segment Type: other
Provision Reference: 
Character Range: 44842–47762

and ability; and
    (b) I will not attempt improperly to discover, or directly or indirectly assist another person to discover, the vote of an elector; and
    (c) I will, unless legally bound to reveal it, keep secret any knowledge obtained in the course of my duties about an elector's vote.

(insert signature of officer)

*Deputy Returning Officer/*Presiding Officer/*Poll Clerk/*officer appointed to issue early voting papers

Declared before me on (insert date)

(insert signature of witness)
*Justice of the Peace/*Returning Officer/*Deputy Returning Officer/*Presiding Officer

* Delete if not applicable

Form I Declaration by scrutineer
(subsection 103 (1B))

DECLARATION BY SCRUTINEER

Local Government Act 1960 (W.A.)(C.I.)

I, (insert full name), of (insert address), a scrutineer appointed by (insert name of candidate) for the election being held on (insert date of election) in the Shire of Christmas Island, declare that:
    (a) I will faithfully observe the provisions of the Local Government Act 1960 (W.A.) (C.I.) relating to the office of scrutineer; and
    (b) I will not attempt improperly to discover, or directly or indirectly assist another person to discover, the vote of an elector; and
    (c) I will, unless legally bound to reveal it, keep secret any knowledge obtained in the course of my duties about an elector's vote.

(insert signature of scrutineer)
Scrutineer

Declared before me on (insert date)

(insert signature of Justice of the Peace)

*Justice of the Peace/*Returning Officer/*Deputy Returning Officer/*Presiding Officer

* Delete if not applicable

Form J Application and declaration under section 111
(subsection 111 (2))

APPLICATION AND DECLARATION UNDER SECTION 111

Local Government Act 1960 (W.A.)(C.I.)

I, (insert full name), of (insert residential address), apply for a vote at the election being held on (insert date of election) in the Shire of Christmas Island.

I declare that:
    (a) I am eligible to be registered on the electoral roll for the Shire because I have attained the age of 18 years and *my name is entered on the Commonwealth electoral roll and my place of living is set out in that roll as a place on Christmas Island/*I am ordinarily resident in Christmas Island Shire; and
    (b) my name has been incorrectly omitted from the current electoral roll for the Shire.

(insert signature of applicant)

Declared before me on (insert date).

(insert signature of electoral officer)
(insert title of electoral officer)
* Delete if inapplicable.

Form K Application and declaration for an early vote
(subsection 115 (2))

APPLICATION AND DECLARATION FOR AN EARLY VOTE

Local Government Act 1960 (W.A.)(C.I.)

I, (insert full name), of (insert residential address), apply for an early vote in relation to the election being held on (insert date of election) in the Shire of Christmas Island.

I declare that:
    (a) I am an elector