ŠStatement of the Poll, after Counting the BallotsŠŠPOLLING SUBDIVISION NO ........................................ŠŠWard of the city of .................................. (or townŠof ..........................................................).ŠŠ===============================================================ŠNumber of Ballot Papers received from the . . Š Returning Officer ............................ . ......------ŠNumber of Ballot Papers cast for ............... . .... .------Š '' '' ............... . .... .------Š '' '' ............... . .... .------Š '' '' ............... . .... .-----Š '' '' spoiled ................ . .... .------Š '' '' rejected ............... . .... .------Š '' '' not used and returned .. . .... . Š .------.------Š Totals ....................................Š---------------------------------------------------------------ŠŠ I hereby certify that the above statement is correct.ŠŠ Given under my hand, at ....................................,Šthis ....................... day of the month of ..............Š ........................., 19.....ŠŠ G. H.Š Deputy Returning Officer.Š