S-4.2, r. 12 - Regulation respecting the election by the public of certain members of the board of directors of the public institution referred to in Part IV.2 of the Act respecting health services and social services

Schedule Disposition versions

2012-09-01

SCHEDULE IX

(s. 33)

PUBLIC ELECTION

NORD-DU-QUÉBEC INSTITUTION

Compilation of vote counts and draw results

Institution: __________________________________________________________________________

Subregion number: ____________________

Polling location(s): ____________________

Polling date: ____________________

Polling period: _______________________

(1) Compilation of vote counts

Candidates Number of votes

(1) ____________________ _______________

(2) ____________________ _______________

(3) ____________________ _______________

(4) ____________________ _______________ Valid ballot papers __________

(5) ____________________ _______________ Rejected ballot papers __________

(6) ____________________ _______________ Total __________

(2) Draw results

The following candidates received the same number of votes:

_______________________________

_______________________________

_______________________________

_______________________________

A draw was held on _____________________, in _____________________

The following candidate’s name was drawn:

_______________________________

_______________________________

Signed in ____________________, on ____________________

_____________________________

Signature

_____________________________

Returning officer’s name

M.O. 2006-014, Sch. IX.