(Section 137)
STATEMENT OF VOTES
School board of ...............................................
Electoral division of .........................................
Polling station No. ..........
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Number of ballot papers received from the . .
returning officer ............................. . . ....
. .
Number of ballot papers cast for ................ . ... .
(Name of the first candidate) . .
. .
Number of ballot papers cast for ................ . ... .
(Name of the second candidate) . .
. .
Number of ballot papers cast for ................ . ... .
(Name of the third candidate) . .
. .
Number of ballot papers cast for ................ . ... .
(Name of the fourth candidate) . .
. .
Number of ballot papers spoiled (not placed in . .
the box) ...................................... . ... .
. .
Number of ballot papers rejected in counting the . .
votes ......................................... . ... .
. .
Number of ballot papers not used ................ . ... .
.-----.-----
. .
Totals .......................................... . ... . ....
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Given under my hand, at ....................................,
this ................................................... 20....
............................
Deputy Returning Officer