Statement of the Poll, after Counting the BallotsPOLLING SUBDIVISION NO ........................................Ward of the city of .................................. (or townof ..........................................................).===============================================================Number of Ballot Papers received from the . . Returning Officer ............................ . ......------Number of Ballot Papers cast for ............... . .... .------ '' '' ............... . .... .------ '' '' ............... . .... .------ '' '' ............... . .... .----- '' '' spoiled ................ . .... .------ '' '' rejected ............... . .... .------ '' '' not used and returned .. . .... . .------.------ Totals ....................................--------------------------------------------------------------- I hereby certify that the above statement is correct. Given under my hand, at ....................................,this ....................... day of the month of .............. ........................., 19..... G. H. Deputy Returning Officer.