Appendix C
FORM R
[Subsections 96(2) and 121(2) of the Act]
Voter’s Registration Form and Poll Book

For the online election for the Position of Member for the Marean Lake Advisory Committee. For this election 'Marean Lake' refers to the the subdivision on SE, SW and NE 12-41-12 W2 in the Rural Municipality of Bjorkdale No. 426.

Your first name: (required)

Your last name: (required)

Your email address to be used for voting: (required)

Please confirm your email address: (required)

We need the civic address of your cabin at Marean Lake. Click here for maps of the different subdivisions if you need to locate your address.

Street number of your cabin: (required)

Street name: (required)
—Please choose an option—Marean Lake RoadHill AvenueBirch StreetCamp RoadEvergreen CrescentLakeside RoadMcCrea RoadPoplar CrescentSpruce WayWillow StreetBear RoadClubhouse RoadCougar RoadDeer DriveElk RoadGaetz CrescentLakeshore DriveLakeview DriveLynx BayRae BayValley View RoadWolf RoadMarean StreetReed RoadWoulfe Street

Complete the following by marking the box to the left of each statement that is correct (you must comply with all 3 to vote):
I am a Canadian citizen
I am the full age of 18 years or will attain the full age of 18 years on or before election day
I have not already voted at this election

Mark one of the following selections, if none apply then you are not eligible to vote.
On the day of the election, I:
a) have resided in the in the subdivisions at Marean Lake for at least three consecutive months immediately preceding the day of the election;b) am the registered owner, (or purchaser pursuant to a bona fide agreement for sale), of taxable land in the subdivision;c) am assessed with respect to land in the subdivision pursuant to a lease, licence, permit or contract in agreement with the registered owner;d) am assessed with respect to an improvement in the subdivision;e) am the holder of a permit in the subdivision with respect to a trailer or mobile home;f) am the spouse of a person described in clause (b), (c), (d), or (e);g) am the chief executive officer of a duly incorporated co-operative, corporation or religious association that is assessed on the last revised assessment roll with respect to property in the subdivision that is not exempt from taxation.

Declarations:
I declare that I am a voter entitled to vote in the Marean Lake Advisory Committee Election.
I declare that the information given by me with respect to the above statements is true in all respects.

Signature:

Date: