New South Wales Repealed Regulations

This legislation has been repealed.

LOCAL GOVERNMENT (ELECTIONS) REGULATION 1998 - SCHEDULE 8

SCHEDULE 8 – Forms

Form 1 - Request for omission or removal of place of living from roll (non-resident electors)

(Clause 16)

To the General Manager,

In reference to my enrolment in(ward)
(local government area)

I,(Surname in BLOCK letters)
(other names in BLOCK letters)
of(full residential address)
request that *my residential address/*the following matter that would disclose or discloses my place of living be omitted or removed from the roll of electors for the abovementioned area (* cross out what does not apply):

(here specify any other matter that would disclose or discloses the place of living).

The disclosure of my place of living on those rolls would place or places my personal safety or that of members of my family at risk. The following are particulars of the relevant risk:

Note:

1 This request must be verified by statutory declaration by the person making the request or by another person. The form of statutory declaration on the back of this form may be used for this purpose.

2 Resident electors who wish to have their address or other matter removed from the electoral roll must make an application to the Australian Electoral Commission or the State Electoral Office.

Request for omission or removal of place of living from roll (non-resident electors)

STATUTORY DECLARATION

I,(full name in BLOCK letters), of
(full address),
do solemnly and sincerely declare as follows:

And I make this solemn declaration conscientiously believing the same to be true, and by virtue of the provisions of the Oaths Act 1900 .

Declared before me at
thisday of(month)(year)

Justice of the Peace

Form 2 - Nomination paper: proposal by electors

(Clause 21 (1) (a))

WE, the undersigned persons enrolled for the election to be held in the

Nomination paper: proposal by electors

FORM OF CONSENT

I, the abovenamed

(1) declare that, to the best of my knowledge and belief, *I was enrolled as an elector for the area on(the closing date for the election)/*my name has been mistakenly or accidentally omitted from the roll of electors (* cross out what does not apply),

(2) consent to my being proposed for nomination,

(3) request that my name be shown on the ballot-papers as

(surname in BLOCK letters, given name in BLOCK letters)

being my full surname and one of my given names or a generally recognised abbreviation or derivative of that given name,

(4) *request/*do not request that the word “Independent” be printed adjacent to my name on the ballot-papers (* cross out what does not apply).

Note:

1 See the back of this Form [or the attached page] for the provisions of the Local Government Act 1993 covering qualification and disqualification for a civic office.

2 Examples of recognised abbreviations or derivatives of given names are Bill for William and Rose for Rosemary. Nicknames, eg Blue or Bunny, are not abbreviations or derivatives. Names are not to be accompanied by any title or academic or other qualification.

3 A person must not propose for nomination more than one candidate for election as mayor in the area, or more candidates for election as councillors in the ward or area than the total number of councillors to be elected for that ward or area (eg if five councillors are to be elected for an area, a person must not propose more than five persons for nomination as councillor for that area).

Nomination paper: proposal by electors

STATISTICAL INFORMATION SHEET

I,(full name in BLOCK letters)
of(full residential address),
declare that:

(tick the squares that apply) (only complete this sheet for ordinary elections, not by-elections):

(a) I am	□ male	□ female, and
(b) I am	□ between 18 and 24 years old
	□ between 25 and 29 years old
	□ between 30 and 39 years old
	□ between 40 and 49 years old
	□ between 50 and 59 years old
	□ between 60 and 69 years old
	□ between 70 and 79 years old
	□ 80 years old or older, and

(c) I was a candidate at the last ordinary election of the council

□ Yes

□ No, and

(d) I consider myself to be an Aboriginal

□ Yes

□ No

I consider myself to be a Torres Strait Islander

□ Yes

□ No.

Note: The information supplied above will be used for statistical purposes only. This information will be treated confidentially. All statistics will be published in aggregate or consolidated form only.

Form 3 - Nomination paper: proposal by registered officer for party

(Clause 21 (1) (b))

I, the person whose name appears on this form as the registered officer for the political party (registered in the Local Government Register of Political Parties) which has endorsed the person proposed for nomination, hereby propose for nomination

(here state name in full in BLOCK letters, occupation and full residential address of the person proposed for nomination) as a candidate at the election to be held in the

I request that the *registered name/*abbreviated name of the party be printed adjacent to the candidate’s name on the ballot-papers (* cross out what does not apply).

Dated thisday of(month)(year)

Nomination paper: proposal by registered officer for party

FORM OF CONSENT

I, the abovenamed,

(1) declare that, to the best of my knowledge and belief, *I was enrolled as an elector for the area on(the closing date for the election)/*my name has been mistakenly or accidentally omitted from the roll of electors (* cross out what does not apply),

(2) consent to my being proposed for nomination,

(3) request that my name be shown on the ballot-papers as

(surname in BLOCK letters, given name in BLOCK letters)

being my full surname and one of my given names or a generally recognised abbreviation or derivative of that given name.

Note:

1 See the back of this Form [or the attached page] for the provisions of the Local Government Act 1993 covering qualification and disqualification for a civic office.

2 Examples of recognised abbreviations or derivatives of given names are Bill for William and Rose for Rosemary. Nicknames, eg Blue or Bunny, are not abbreviations or derivatives. Names are not to be accompanied by any title or academic or other qualification.

Nomination paper: proposal by registered officer for party

STATISTICAL INFORMATION SHEET

I,(full name in BLOCK letters)
of(full residential address),
declare that:

(tick the squares that apply) (only complete this sheet for ordinary elections, not by-elections):

(a) I am	□ male	□ female, and
(b) I am	□ between 18 and 24 years old
	□ between 25 and 29 years old
	□ between 30 and 39 years old
	□ between 40 and 49 years old
	□ between 50 and 59 years old
	□ between 60 and 69 years old
	□ between 70 and 79 years old
	□ 80 years old or older, and

(c) I was a candidate at the last ordinary election of the council

□ Yes

□ No, and

(d) I consider myself to be an Aboriginal

□ Yes

□ No

I consider myself to be a Torres Strait Islander

□ Yes

□ No.

Note: The information supplied above will be used for statistical purposes only. This information will be treated confidentially. All statistics will be published in aggregate or consolidated form only.

Form 4 - Ballot-paper

(Clause 38)

Election of(here insert the number of vacancies
which the election is being held to fill and whether the election is of councillors or of the mayor) held on(insert election day).

Ballot-paper

Candidates

(If the returning officer has accepted an application to print the name of a political party or the word “Independent” adjacent to the name of a candidate, the name or word must be printed there.)

Ballot-paper

CANDIDATES

VALADON, Susan
(Blackacre)
ARRAIZA, Ramon
VALADON, Sue
(Tenterfield)
BROWN, Denise
KABOS, Colin
DAVIS, Ron
(Storekeeper, Tenterfield)
DAVIS, Ron
(Grazier, Tenterfield)
HO, Liam
MAHON, Sharon
WHITMORE, Kim

(The following directions are to appear on the front or the back of the ballot-paper. If the directions appear on the back of the ballot-paper, an appropriate reference to their appearance on the back must be made on the front of the ballot-paper.)

Ballot-paper

Directions for Voting

(Here insert the following directions if only one candidate is to be elected)

Place the number “1” in the square next to the candidate of your choice.

If you wish to vote for any more candidates, place consecutive numbers starting with “2” in the squares next to those candidates in order of your preferences for them. (This second direction should only be inserted if there are more than 2 candidates)

(Here insert the following directions if 2 or more candidates are to be elected)

Place the numbers (here insert the sequence of numbers that corresponds to the number of candidates to be elected) in the squares next to the (here insert the number of candidates to be elected) candidates in order of your preferences for them.

If you wish to vote for any more candidates, place consecutive numbers starting with (here insert the next number after the number of the candidates to be elected) in the squares next to those candidates in order of your preferences for them. (This second direction should only be inserted if there are at least 2 more candidates than candidates to be elected)

ELECTORS PLEASE NOTE: YOU MUST NOT TAKE A BALLOT-PAPER OUT OF THE POLLING PLACE.

Form 5 - Ballot-paper

(Clause 38)

Election of (here insert the number of vacancies which the election is being held to fill) councillors held on (insert election day)

Ballot-paper

Candidates

* Here insert name of registered party if to be printed.

** Here insert the word “Independent” if to be printed.

*** Here insert name of registered party or word “Independent” if to be printed.

(The following directions are to appear on the front or the back of the ballot-paper. If the directions appear on the back of the ballot-paper, an appropriate reference to their appearance on the back must be made on the front of the ballot-paper.)

Ballot-paper

Directions for Voting

Place the numbers (here insert the sequence of numbers that corresponds to the number of candidates to be elected) in the squares next to the (here insert the number of candidates to be elected) candidates in order of your preferences for them.

If you wish to vote for any more candidates, place consecutive numbers starting with (here insert the next number after the number of the candidates to be elected) in the squares next to those candidates in order of your preferences for them. (This second direction should only be inserted if there are at least 2 more candidates than candidates to be elected)

ELECTORS PLEASE NOTE: YOU MUST NOT TAKE A BALLOT-PAPER OUT OF THE POLLING PLACE.

Form 6 - Ballot-paper

(Clause 38)

Election of (here insert the number of vacancies which the election is being held to fill) councillors held on (insert election day).

Ballot-paper

Directions for Voting

(The following directions are to appear on the front or the back of the ballot-paper. If the directions appear on the back of the ballot-paper, an appropriate reference to their appearance on the back must be made on the front of the ballot-paper.)

ELECTORS PLEASE NOTE: YOU MUST NOT TAKE A BALLOT-PAPER OUT OF THE POLLING PLACE.

Form 7 - Application for postal vote

(Clause 44)

To the returning officer for(here specify local government area).

I declare that:

1 My full name is

(in BLOCK letters)

2 I am entitled to vote at the forthcoming election to be held in theward of the abovementioned local government area and the address of the land to which my entitlement relates (as resident, non-resident owner, occupier or ratepaying lessee) is

3 If my name is not on the roll of electors, I claim to vote under section 305 of the Local Government Act 1993 .

4 I have not already voted in connection with this election.

5 I am making this application for the following reason or reasons (tick the squares that apply):

□	(a)	I will not throughout the hours of polling on election day be within the ward or area for which this election is being held,
□	(b)	I will not throughout the hours of polling on election day be within 8 kilometres by the nearest practicable route of any polling place at which I am entitled to vote,
□	(c)	I will throughout the hours of polling on election day be travelling under conditions which will prevent me from attending at any such polling place to vote,
□	(d)	I am seriously ill or disabled and will be prevented by that illness or disability from attending at any such polling place to vote,
□	(e)	I will be prevented by approaching maternity from attending at any such polling place to vote,
□	(f)	I am, by reason of my membership of a religious order or my religious beliefs, prevented from attending at any such polling place on election day or prevented from voting throughout the hours of polling on election day or throughout the greater part of those hours,
□	(g)	I am, by reason of my being kept in prison, prevented from attending at any such polling place to vote,
□	(h)	I will be, at a place other than a hospital, caring for a person who requires my care for medical reasons and because of that I will be prevented from attending at any such polling place to vote,
□	(i)	I will, by reason of my being engaged for fee, gain or reward in any work throughout the hours of polling on election day, be prevented from attending at any such polling place to vote.

I hereby apply for a postal ballot-paper and postal voting envelope so that I may vote at the abovementioned election. Please send them to the address below.

(address to which ballot-paper and envelope are to be sent: for a resident voter this can be any address, but for a non-resident voter it must be the voter’s residential address)

Application for postal vote

STATEMENT OF WITNESS

I am of or above the age of 18 years and am not a candidate or the agent of a candidate at the abovementioned election, and

I am satisfied as to the identity of the applicant, and

I have seen the applicant sign the application, and

I know, or have satisfied myself by inquiry, that the statements contained in the application are true.

Application No

Form 8 - Postal vote declaration and declaration where name not on roll

(Clauses 48 and 74)

Application No

Ideclare that:

1 I have not already voted in connection with the forthcoming election being held onin theward of(local government area).

2 I am still entitled to vote at the election and the address of the land to which my voting entitlement relates (as resident, non-resident owner, occupier or ratepaying lessee) is:
(full address)

3 To the best of my knowledge and belief I am enrolled on the New South Wales or Commonwealth electoral roll.

4 The postal vote to which this declaration relates was completed before the close of the poll in the election.

If or because my name is not on the roll of electors being used at the election, in accordance with section 305 of the Local Government Act 1993 I claim to be entitled to vote at the election.

Postal vote declaration and declaration where name not on roll

Witnessing of declaration

Postal vote declaration and declaration where name not on roll

Postal votes

I am at least 18 years old and am not a candidate or an agent of a candidate at the abovementioned election, and

I am satisfied as to the identity of the elector, and

I have seen the elector sign the declaration, and

I know, or have satisfied myself by reasonable inquiry, that the statements contained in the declaration are true.

The declaration was made before the close of the poll in the election.

Address of witness

Postal vote declaration and declaration where name not on roll

Voting at polling place

I, the returning officer/substitute returning officer/senior deputy returning officer, have seen the elector sign the declaration.

Form 9 - Postal ballot-paper lost or not received

(Clause 48)

To the returning officer/senior deputy returning officer(ward)
(local government area)

I,(full name as it appears on the roll),
of(full address as it appears on the roll),

□ declare that I have lost or have not received a postal ballot-paper in connection with the election being held in the abovementioned ward or area, even though a mark has been placed against my name on the roll to indicate that a postal ballot-paper has been issued to me.

□ declare that I have lost or have not received a declaration envelope in connection with the election being held in the abovementioned ward or area, even though a record has been made that such an envelope has been issued to me.

Tick the square that applies. Tick both squares if both apply.

I claim to vote under clause 48 of the Local Government (Elections) Regulation 1998 .

Declared before me, thisday of(month)(year) at the
polling place.

Form 10 - Application for pre-poll vote

(Clause 52)

To the returning/senior deputy returning officer for(local government area).

I declare that (tick the square that applies and complete the appropriate declaration):

I apply to vote before election day at the abovementioned election.

Declared before me, thisday of(month)(year).

Form 11 - Declared institution vote declaration

(Clause 59)

To the returning/senior deputy returning officer for
(local government area).

I declare that (tick the square that applies and complete the appropriate declaration):

Declared before me, thisday of(month)(year)

Form 12 - Declaration by an elector whose place of living is not on the roll

(Clause 70)

To the returning officer/senior deputy returning officer(ward)(local government area)
Surname of elector(in BLOCK letters)
Given names(in BLOCK letters)

Address for which I claim to be enrolled

If you have changed your name since you enrolled for the above address please print your previous name here

I am entitled to vote. I have not already voted at this election.

I declare that the information shown above is true.

Signature of elector

Polling place

Ward

Area

Date

Form 13 - Voting if name already marked on roll

(Clause 75)

To be made by person claiming to vote when the person’s name has already been marked off at the same polling-place)

To the returning/senior deputy returning officer(ward)
(local government area)
I,(name in full as it appears on the roll),
of(address in full)
declare that:

1 My name appears on the roll used at the
polling place opposite the numberon that roll.

2 I have not voted in connection with the election for the abovementioned ward or area being held today, despite the fact that the roll has been marked to indicate that a ballot-paper has purportedly been issued to me at the polling-place.

I claim to vote under clause 75 of the Local Government (Elections) Regulation 1998 .

Declared before me, thisday of(month)(year) at the
polling-place.

Form 14 - Account of ballot-papers: polling place

(Clause 79)

To the returning officer,(local government area).

Ballot-papers received from returning officer for use at the polling place

Ballot-papers written out by senior deputy returning officer

Ballot-papers unused

Ballot-papers spoilt

Ballot-papers used

Ballot-papers issued to, but not returned by, electors

Tendered votes

Section 305 votes

Postal ballot-papers delivered up and cancelled

Form 15 - Penalty notice-Failure to vote

(Clause 88)

The Electoral Commissioner’s records indicate that you appear to have failed to vote at the election/constitutional referendum held on

The maximum penalty for failing to vote is (insert maximum amount of penalty).

IF YOU DID VOTE:

Please complete and sign the following declaration.
I declare that I did vote at(polling place)
in respect of the election/constitutional referendum held on(date)

IF YOU DID NOT VOTE:

1 If you think you have a sufficient reason for not voting, please complete and sign the following declaration:

I declare that I did not vote at the election/constitutional referendum held on
(date) for the following reason:

2 If you do not think you have a sufficient reason for not voting, you may dispose of the matter by:

• paying a penalty of (insert amount of penalty) to the Electoral Commissioner within 28 days of the date of this notice
OR

• having the matter dealt with by a court, where the maximum penalty is (insert maximum amount of penalty) and you may also have to pay court costs.

IF A DECLARATION OF VOTING IS NOT MADE, A REASON FOR NOT VOTING IS NOT GIVEN AND THE PENALTY IS NOT PAID WITHIN 28 DAYS, PROCEEDINGS MAY BE TAKEN AGAINST YOU IN COURT.

Penalty notice-Failure to vote

PROCEDURE FOR PAYMENT OF PENALTY OR OFFER OF EXPLANATION

Deliver or send the penalty or the explanation to the Electoral Commissioner at
(address of Electoral Commissioner’s Office)

Cheques and money orders should be crossed, marked not negotiable and made payable to the Electoral Commissioner.

DO NOT SEND CASH. PART PAYMENT OF THIS PENALTY CANNOT BE ACCEPTED

The PENALTY for any person making a false statement in this Form is (insert maximum amount of penalty).

THIS FORM MUST BE DELIVERED OR SENT WITH YOUR PAYMENT OR EXPLANATION

□ TICK IF RECEIPT IS REQUIRED

Form 16 - Constitutional referendum or council poll paper

(Schedule 6, clause 4)

(local government area)
Constitutional referendum/council poll taken on(date)