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 VI

(s. 25)

PUBLIC ELECTION

NORD-DU-QUÉBEC INSTITUTION

Voter Declaration

Institution: __________________________________________________________________________

Subregion number: __________

DECLARATION

I hereby declare that

— I am 18 years of age or over

— The postal code of my primary residence is __________

— My primary residence is located in the above subregion

— I do not work for the above institution or at a center operated by said institution

_______________________________

Nom

_______________________________

Signature

_______________________________

Date

SCRUTINEER: _______________________________

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