these regulations (N.S. Reg. 84/1997) (just regulations regs melforms.htm)

N.S. Reg. 84/1997

Nova Scotia — Regulations

This consolidation is unofficial and is for reference only.

For the official version of the regulations, consult the original documents on file with the Office of the Registrar of Regulations , or refer to the Royal Gazette

Part II .

Regulations are amended frequently.

Please check the list of Regulations by Act to see if there are any recent amendments to these regulations filed with our office that are not yet included in this consolidation.

Although every effort has been made to ensure the accuracy of this electronic version, the Office of the Registrar of Regulations assumes no responsibility for any discrepancies that may have resulted from reformatting.

Municipal Elections Act Forms

prescribed under subsection 167(1) of the

Municipal Elections Act

R.S.N.S. 1989, c. 300

O.I.C. 97-469 (July 15, 1997), N.S. Reg. 84/1997

amended to N.S. Reg. 176/2024 (effective August 15, 2024)

Please note: this table of contents is provided for convenience of reference and does not form part of the regulations.

Click here to go to the text of the regulations .

Form 1: Oath or Affirmation of Returning Officer/AssistantReturning Officer/Revising

Officer

Form 2: Oath or Affirmation of Deputy Returning Officer/Poll Clerk

Form 3: Certificate in Respect to Charges that are Liens/Taxes

Form 4: Oath or Affirmation of Registrar of Voters

Form 5: Oath or Affirmation of Enumerator

Form 6: Index Sheet (Alphabetical)

Form 6A: Index Sheet (Geographic)

Form 7: Enumerator’s Certificate

Form 8: Oath or Affirmation of Elector Applying To Be Added to the List of Electors

Form 8A [repealed]

Form 8B [repealed]

Form 8C [repealed]

Form 9: Oath or Affirmation of Person Applying for Amendment of the List of Electors

Form 9A [repealed]

Form 10: Oath or Affirmation of Person Applying to Correct Errors on List of Electors

Form 10A [repealed]

Form 10B [repealed]

Form 11: Nomination Paper (Mayor or Other Council Member)

Form 11A [repealed]

Form 11B: Nomination Paper ( Conseil scolaire acadien provincial )

Form 11C: [repealed]

Form 12: Affidavit re Removal of Advertising Materialsand Return of Lists of Electors

Form 12A: Declaration of Candidate Withdrawing from Nomination

Form 13: Ballot paper

Form 13A: Ballot Paper/Plebiscite

Form 14: Format of Poll Book

Form 14A: Format of Poll Book/Plebiscite

Form 15: Appointment of Agent (Polling Station)

Form 16: Oath or Affirmation of Agent Representing a Candidate (Polling Station)

Form 17: Appointment of Official Agent

Form 17A: Oath (or Affirmation) of Official Agent

Form 18: Declaration of Person Applying for a Transfer Certificate

Form 19: Transfer Certificate (Polling Station)

Form 20: Transfer Certificate (Polling District)

Form 21: Application for a Proxy Vote

Form 22: Number ____, Proxy Paper

Form 23: Directions to Electors

Form 23A [repealed]

Form 24: Elector’s Oath or Affirmation of Qualification at Poll

Form 24A [repealed]

Form 25: Oath or Affirmation of Elector Requiring Assistance

Form 26: Oath or Affirmation of Friend of Elector Requiring Assistance (Unrelated)

Form 26A: Oath or Affirmation of Friend of Elector RequiringAssistance

(Candidate/Relative)

Form 27: Oath or Affirmation of Interpreter

Form 28: Oath or Affirmation as to Error on List

Form 29: Oath or Affirmation of a Personated Elector

Form 30: Record of Poll

Form 30A: Record of Poll/Plebiscite

Form 31: Oath or Affirmation of Elector Not on List of Electors on Polling Day

Form 31A: [repealed]

Form 31B: Oath or Affirmation of Elector Not on List of Electors on Polling Day (Where

elector can vote only for Conseil scolaire acadien provincial )

Form 31C [repealed]

Form 31D [repealed]

Form 32: Affidavit of Proxy Voter

Form 33: Statement of Poll (One Candidate or Matter)

Form 34: Statement of Poll (More Than One Candidate or Matter)

Form 34A: Statement of Poll to be Completed when Conseil scolaire acadien

provincialBallots to be Transferred for Counting

Form 35: Tally Sheet For the Counting of Votes

Form 35A: Tally Sheet for the Counting of Votes/Plebiscite

Form 36: Tally Sheet for the Counting of Votes At a Plebiscite

Form 37: Persons Who Have Voted at the Advance Poll

Form 38: Recapitulation Sheet

Form 38A [repealed]

Form 39: Council Member’s Oath of Allegiance and of Office

Form 40: Candidate’s Campaign Contributions Disclosure Statement

Form 41: Association’s Campaign Contributions Disclosure Statement

Form 42 [repealed]

Form 43 [repealed]

Form 44: Statement of Poll, Consolidated Count of Conseil scolaire acadien provincial

Ballots(One Member to be Elected from the CSAP Electoral District)

Form 45: Statement of Poll, Consolidated Count of Conseil scolaire acadien provincial

Ballots(More than One Member to be Elected from the CSAP Electoral District)

Form 46: Record of Objections

Form 1: Oath or Affirmation of Returning Officer/Assistant

Returning Officer/Revising Officer

(Sections 4, 8, 33)

I, ____________ swear (or solemnly affirm) that I will act faithfully and impartially in the

performance of my duties as Returning Officer/Assistant Returning Officer/ Revising Officer in

the Town/Municipality/Regional Municipality of _____________.

Sworn (or affirmed) at

in the County of

this _____ day of ,

_______, before me

________________________ ____________________________________________

(see

Section 146) Returning Officer/Assistant Returning Officer/Revising

Officer

________________________________________________________________

Form 2: Oath or Affirmation of Deputy Returning Officer/Poll Clerk

(Sections 8, 59)

I, _____________, swear (or solemnly affirm) that I will act faithfully and impartially in the

performance of my duties as _____________, that at the election to be held in the Town/

Municipality/Regional Municipality of _________ on the __ day of ______, __, I will not

attempt in any way unlawfully to ascertain the candidate or candidates for whom a voter has

voted, and will not in any way aid in the unlawful discovery of the same, and will keep secret

all knowledge which may come to me of the persons for whom any voter has voted.

I have not been convicted of a corrupt practice, as defined in the Municipal Elections Act , or of

bribery.

Sworn (or affirmed) at

in the County of

this _____ day of ,

_______, before me

__________________________ ______________________________

(see

Section 146) Deputy Returning Officer/Poll Clerk

________________________________________________________________

Form 3: Certificate in Respect to Charges that are Liens/Taxes

(Sections 17, 44, 45)

I certify that as of the ______________ day of ____________________, ______, (nomination day)

___________________________________ (name of candidate) has fully paid all (

i) the charges

that are liens on property that are due, (ii) all the municipal taxes that are due, and (iii) all

instalments or interim payments that are due as of nomination day have been paid to the

Town/Municipality/Regional Municipality of ______________________ from the candidate.

______________________________________

Clerk, Treasurer, Collector or other official

having knowledge of the facts

________________________________________________________________

Form 4: Oath or Affirmation of Registrar of Voters

(Section 22)

I, _____________________ swear (or solemnly affirm) that I will act faithfully and impartially

in the performance of my duties as registrar of voters in the Town/ Municipality/Regional

Municipality of ________________, will take all necessary precautions and care to ensure the

accuracy of the enumeration, and will protect the confidentiality of elector information.

Sworn (or affirmed) at

in the County of

this _____ day of ,

_______, before me

_________________________ ___________________________________

(see

Section 146) Registrar of Voters

________________________________________________________________

Form 5: Oath or Affirmation of Enumerator

(Section 23)

I, ________________________________ (name in full) of ____________________, (residence)

appointed enumerator for the Town/Municipality/Regional Municipality of ____________

swear (or solemnly affirm) that I will act faithfully in my capacity as enumerator without

partiality and will take all necessary precautions and care to ensure that the enumerators’ index

sheet contains correct information concerning all qualified electors in Polling Division Number

_____ and will not contain the names of any persons who are not qualified. I will protect the

confidentiality of elector information that is provided to me.

Sworn (or affirmed) at

in the County of

this _____ day of ,

_______, before me

________________________ ____________________________________

(see

Section 146) Enumerator

________________________________________________________________

Form 6: Index Sheet (Alphabetical)

(Section 25)

*Polling Division (Number, Name or Description) __________________________________

Consecutive

Number

(Optional)

Name

(surname, first name

and middle name or

initial)

Address

Civic Address (number,

street, community)

Mailing Address

(if different than civic–

include postal code)

(if necessary)

Date of birth

(to be removed

from final list of

electors)

* Returning Officer to indicate how poll is to be identified

________________________________________________________________

Form 6A: Index Sheet (Geographic)

(Section 25)

*Polling Division (Number, Name or Description)

Consecutive

Number

(Optional)

Civic

Number

Name

(surname, given name and

middle name or initial)

Mailing Address

(if different from

civic–include postal

code) (if necessary)

Date of birth

(to be removed from

final list of electors)

(Name of street/avenue/road/highway and community):

* Returning Officer to indicate how the poll is to be identified

________________________________________________________________

Form 7: Enumerator’s Certificate

(Section 27)

I/We, the undersigned enumerator(s), certify that I/we have taken all necessary precautions and

care to ensure that the index sheets attached contain correct information concerning the

qualified electors in Polling Division Number ________ and do not contain the names of any

persons who are not so qualified.

Dated this ______ day of _____________, ______

_______________________________

Enumerator(s)

________________________________________________________________

Form 8: Oath or Affirmation of Elector Applying To

Be Added to the List of Electors

(Section 36, 38, 50A )

I swear (or solemnly affirm) that:

1. On this date, I actually reside in Polling Division Number ____________ of Polling

District Number _____________ of the Town/Municipality/Regional Municipality of

___________________________________________________ (the “Municipality”).

2. As of the first polling day in this election, I will have been ordinarily resident in:

•the Province of Nova Scotia for a period of six (6) months; and

•the Municipality (or in an area annexed to the Municipality).

3. As of the first advance polling day in this election, I will have been or will be a Canadian

citizen and of the full age of eighteen years or more.

4. I am not the returning officer, a person serving a sentence in a penal or reform institution,

or a person convicted of bribery under the Municipal Elections Act in the six years

preceding ordinary polling day.

5. I wish to be added to the list of electors for the purpose of voting in this election.

Name of Elector

(please print)

Civic Address of Elector

(and mailing address, if necessary)

Date of Birth

Sworn (or affirmed) at _____________________

in the _____________ of ___________________

this _______ day of ________________

_________, before me

______________________________ ____________________________

Revising Officer Applicant

The Voters List may be used in future municipal, provincial or federal elections.

(Date of birth will be removed from the final list of electors.)

________________________________________________________________

Form 8A [repealed]

Form 8B [repealed]

Form 8C [repealed]

________________________________________________________________

Form 9: Oath or Affirmation of Person Applying for

Amendment of the List of Electors

(Section 35, 36)

I ____________________________ of __________________________, swear (or solemnly

(name) (address)

affirm) that I believe that ______________________ of______________________________,

(name) (address)

registered on the list of electors for Polling Station Number ________ in Polling District

Number ________, in the Town/Municipality/Regional Municipality of

________________________(the “Municipality”) should not be on the list because (place a

check mark next to the applicable statement)

_______ the person does not reside at the address shown;

_______ the person is not the full age of eighteen years and will not be as of the first

advance polling day;

_______ the person is not a Canadian citizen or will not be as of the first advance

polling day;

_______ the person has not been or will not have been ordinarily resident in:

• the province of Nova Scotia for six (6) months; and

• the Municipality.

as of the first advance polling day in this election;

_______ the person is dead.

Sworn (or affirmed) at ____________________

in the _____________ of _________________________

this _______ day of ______________________,

_________, before me

_________________________________ _______________________________

Revising Officer Applicant

________________________________________________________________

Form 9A [repealed]

________________________________________________________________

Form 10: Oath or Affirmation of Person Applying to

Correct Errors on List of Electors

(Subsection 37(2))

I _____________________, (name of elector/agent of elector) of _______________________, (address)

swear (or solemnly affirm) that _____________________, (name of elector) whose address is given

as ____________________________, (address as on official list of voters) appears with an error

(errors) on the preliminary list of electors, and should be shown on the list as

____________________________ ______________________________

(name) (address)

Sworn (or affirmed) at

in the County of

this _____ day of ,

_______, before me

_____________________________ ______________________________

Revising Officer Applicant

________________________________________________________________

Form 10A [repealed]

Form 10B [repealed]

________________________________________________________________

Form 11: Nomination Paper (Mayor or Other Council Member)

(Section 44)

We, the qualified electors whose names appear on the amended list of electors of the

Town/Municipality/Regional Municipality of ______________________________________ ,

nominate__________________________________________________________________ of

(name)

____________________________________________________________________________,

(civic address)

_____________________________________ _______________________________

(postal code)

____________________________________________________________________________

(include mailing address if different than civic address )

as a candidate for the office of _______________________________ for the election to be held

on the _______________ day of ______________________________, __________________.

Name (please print) Civic Address Signature

_____________________ _______________________ _______________________

Note:

1. These electors must be qualified to vote at the election of the candidate. At least 5

qualified electors must sign the nomination form.

2. Nomination forms are open for inspection by the public once signed by the

Returning Officer.

Consent and Oath or Affirmation of Candidate

I solemnly swear (or affirm) that:

1. I (The candidate), _________________________________, consent(

s) to the nomination.

(name as it should appear on the ballot paper)

2. I am (The candidate is) a Canadian citizen.

3. I am (The candidate is) of the full age of eighteen years.

4. I have (The candidate has) been ordinarily a resident in the Town/Municipality/Regional

Municipality of ____________________________________________, (or in an area

annexed to the Town/Municipality/Regional Municipality), for a period of six months

preceding nomination day and I intend (the candidate intends) to continue to so reside.

5. I am (The candidate is) not indebted to the Town/Municipality/Regional Municipality of

___________________________ for any charges that are liens on property or taxes, or all

instalments or interim payments that are due as of nomination day have been paid, and a

certificate from the __________________________________ to this effect is attached.

6. I have (The candidate has) not been convicted of bribery or of committing a corrupt

practice under the Municipal Elections Act within the five years preceding nomination day.

7. I have (The candidate has) read the Sections of the Municipal Elections Act related to

persons disqualified to vote, to be nominated or to serve on a council and none of the

reasons for disqualification listed in those Sections apply to me (the candidate).

8. I have (The candidate has) read and I understand (the candidate understands) the

provisions of the Municipal Elections Act related to the requirement to take a leave of

absence if I am (the candidate is) an employee of the Town/Municipality/Regional

Municipality within the meaning of those provisions.

9. I understand (the candidate understands) that a list of electors is permitted to be used for

election purposes and for no other purposes and that it is not to be open for inspection,

disposed of or sold.

10. I understand (the candidate understands) that, within 7 days following the election, all

copies of the list of electors in my (the candidate’

s) possession must be returned and all

electronic copies must be returned, destroyed or deleted. I further understand (The

candidate understands) that if I fail (the candidate fails) to do so, I forfeit (the candidate

forfeits) any candidate’s deposit to which I (the candidate) might otherwise be entitled to

receive.

11. I (The candidate) will accept the office of _________________________________ if

elected.

12. I appoint (The candidate appoints) _______________________________________ of

_____________________ as my (the candidate’

s) official agent under the Municipal

Elections Act .

Sworn (or affirmed) at _________________________

in the County of ______________________________

this ___________ day of _______________________

_______________, before me

_________________________________ _______________________________

Authorized Administrator of Oath Candidate (or Agent if authorized

(See

Section 146) and the authorization is attached)

Receipt

Received from the above-named candidate or from the candidate’s agent on the candidate’s

behalf a completed nomination paper and the sum of _____________ in legal tender or a

certified cheque or money order made payable to the Town/Municipality/Regional Municipality

of __________________________ as a deposit pursuant to the Municipal Elections Act .

Dated at ________________________ this__________ day of ___________________, _____.

_______________________________

Returning Officer

________________________________________________________________

Form 11A [repealed]

________________________________________________________________

Form 11B: Nomination Paper ( Conseil scolaire acadien provincial )

(Section 44)

(Section 18, Conseil scolaire acadien provincial Act )

District__________________________________________

(name)

We, the qualified electors whose names appear on the amended list of electors for the

municipality shown opposite each name, nominate: _________________________________ of

(name)

____________________________________________________________________________,

(civic address)

_________________________________________ _______________________________

(postal code)

____________________________________________________________________________

(include mailing address if different than civic address)

as a candidate for the office of ____________________________ for the election to be held on

the ____________ day of __________________________________, __________________.

(Note: Nominators to sign below and also to sign “Statement of Nominators”.)

Name (please print) Civic Address Municipality

______________________ _________________________________________________

______________________

Signature

Name (please print) Civic Address Municipality

______________________ _________________________________________________

______________________

Signature

Name (please print) Civic Address Municipality

______________________ _________________________________________________

______________________

Signature

Name (please print) Civic Address Municipality

______________________ _________________________________________________

______________________

Signature

Name (please print) Civic Address Municipality

______________________ _________________________________________________

______________________

Signature

Note:

1. These electors must be qualified to vote at the election of the CSAP candidate.

2. Nomination forms are open for inspection by the public once signed by the

Returning Officer.

Statement of Nominators

Under the Conseil scolaire acadien provincial Act , only an “entitled person” may nominate a

candidate for election as a member of the Conseil scolaire acadien provincial . “Entitled person”

is defined to mean an entitled parent or a person who, not being an entitled parent, would be an

entitled parent if the person were a parent.

Under the Conseil scolaire acadien provincial Act , an “entitled parent” is defined to mean a

parent who is a Canadian citizen AND

(

a) whose first language learned and still understood is French; OR

(

b) who received primary school instruction in Canada in a French-first-language

education program; OR

(

c) of whom any child has received or is receiving primary or secondary school

instruction in Canada in a French-first-language education program (note that the

definition of “parent” does not include a guardian or person acting in loco parentis to

a child).

I state that I am an “entitled person” within the meaning of this definition.

___________________________________ _______________________________

Name (please print) Signature

___________________________________ _______________________________

Name (please print) Signature

___________________________________ _______________________________

Name (please print) Signature

___________________________________ _______________________________

Name (please print) Signature

___________________________________ _______________________________

Name (please print) Signature

Statement of Candidate

Under the Conseil scolaire acadien provincial Act , only an “entitled person” may be a member

of the Conseil scolaire acadien provincial . “Entitled person” is defined to mean an entitled

parent or a person who, not being an entitled parent, would be an entitled parent if the person

were a parent.

Under the Conseil scolaire acadien provincial Act , an “entitled parent” is defined to mean a

parent who is a Canadian citizen AND

(

a) whose first language learned and still understood is French; OR

(

b) who received primary school instruction in Canada in a French-first-language

education program; OR

(

c) of whom any child has received or is receiving primary or secondary school

instruction in Canada in a French-first-language education program (note that the

definition of “parent” does not include a guardian or person acting in loco parentis to

a child).

I state that I am an “entitled person” within the meaning of this definition.

____________________________________

Candidate

(Note: This Statement must be signed by the candidate; it cannot be signed by the official

agent.)

Consent and Oath or Affirmation of Candidate

I swear (or solemnly affirm) that:

1. I (The candidate), __________________________________________, consent(

s) to the

(name as it should appear on the ballot paper)

nomination.

2. I am (The candidate is) a Canadian citizen.

3. I am (The candidate is) of the full age of eighteen years.

4. I have (The candidate has) been ordinarily resident in the electoral district for a period of

six months preceding nomination day or the day of appointment, and continue(

s) to so

reside.

5. I have (The candidate has) not been convicted of any corrupt practice or bribery under the

Municipal Elections Act within the ten years preceding nomination day.

6. I have (The candidate has) read and I understand (the candidate understands) all the

provisions of the Conseil scolaire acadien provincial Act related to the disqualifications of

a person from being nominated or to serve as a member of the Conseil scolaire acadien

provincial and none of those reasons for disqualification apply to me (the candidate).

7. I understand (The candidate understands) that a list of electors is permitted to be used for

election purposes and for no other purposes and that it is not to be open for inspection,

disposed of or sold.

8. I understand (The candidate understands) that, within 7 days following the election, all

copies of the list of electors in my (the candidate’

s) possession must be returned and all

electronic copies must be returned, destroyed or deleted. I further understand (The

candidate understands) that if I fail (the candidate fails) to do so, I forfeit (the candidate

forfeits) any candidate’s deposit to which I (the candidate) might otherwise be entitled to

receive.

9. I (The candidate) will accept the office of the member of the Conseil scolaire acadien

provincial if elected.

10. I (The candidate) appoint(s) _____________________ of __________________________

(name) (address)

as my (the candidate’

s) official agent under the Municipal Elections Act .

Sworn (or affirmed) at _________________________

in the County of ______________________________

this ___________ day of _______________________

_______________, before me

___________________________________ _______________________________

Authorized Administrator of Oath Candidate (or Agent if authorized

(See

Section 146) and the authorization is attached)

Receipt

Received from the above-named candidate or from the candidate’s agent on the candidate’s

behalf a completed nomination paper and the sum of __________________________ in legal

tender or a certified cheque or money order made payable to the Town/Municipality/Regional

Municipality of _____________________________ as a deposit pursuant to the Municipal

Elections Act .

Dated at ______________________ this__________ day of _____________________, _____.

_______________________________

Returning Officer

(A translation of this form is available in French.)

________________________________________________________________

Form 11C: [repealed]

________________________________________________________________

Form 12: Affidavit re Removal of Advertising Materials

and Return of Lists of Electors

(Section 51)

I, ___________________________________, (name of candidate) solemnly swear (or affirm) that:

1. I was a candidate for the office of _______________________ of the ________________

at the election held on the ______ day of _______________, ____.

2. I have removed or caused to be removed all advertising and election materials which were

posted or displayed on my behalf.

3. I recognize that failure to remove advertising and election materials from public places is a

violation of the Municipal Elections Act .

4. I have returned all copies of the list of electors in my possession, and I have either

returned, destroyed or deleted any electronic copies provided to me or made by me.

Sworn (or affirmed) at __________________

in the County of _______________________

this ________ day of ____________________,

______, before me

_____________________ ______________________________________

(see

Section 146) Candidate (or Official Agent if authorized and

the authorization is attached)

(TO BE FILED WITHIN 7 DAYS AFTER ELECTION DAY)

________________________________________________________________

Form 12A: Declaration of Candidate Withdrawing from Nomination

(Section 53)

To: Returning Officer,

Town/Municipality/Regional Municipality of _________________________________

I, _______________________________, (candidate’s name) officially nominated as a candidate at

the election now pending, withdraw as a candidate.

Dated at __________________________,

this _______ day of _______________.

______________________________________

Candidate/Official agent on behalf of candidate

________________________________________________________________

Form 13: Ballot paper

(Section 66)

FRONT

Stub

Counterfoil

Election for...................

Vote for not more than.........

candidate(

s) James Allen BROWN ◯

Frederika COOPER ◯

Ross George FINDLAY ◯

Jean Paul SURETTE ◯

BACK

Stub

Counterfoil

No. 000000

...................................

No. 000000

...................................

_________________

D.R.O. Initials

_______ of _______

Election for _______

_________________

Polling District (or

Ward) No. _____

_________, _______

line of perforation

name of municipality

name of office for

councillors or school

board members

elected by ward or

polling district only

date of ordinary

polling day

________________________________________________________________

Form 13A: Ballot Paper/Plebiscite

(Section 66)

FRONT

Stub

Counterfoil

DO YOU FAVOUR . . . . . . . . . .? YES ◯

NO ◯

No. 000000

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No. 000000

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

____________________

D.R.O. Initials

__________of_________

Plebiscite respecting _________

__________________________

_______________, __________

BACK

Stub

line of perforation

Counterfoil

name of municipality

description of question

date of ordinary

polling day

________________________________________________________________

Form 14: Format of Poll Book

(Section 68)

1. The cover of the poll book shall bear the subject of the election, the polling district

number, and the date of ordinary polling day.

2. The first page of the poll book shall contain Form 2.

3. The second page of the poll book shall contain Form 16.

4. Form 24 shall be on the third page, then Forms 25, 26, 26A, 27, 28, and 29 shall follow.

5. Then shall follow twelve pages of Form 30.

6. Then shall follow three pages of Form 31.

7. Then shall follow two pages of Form 31B.

8. Then shall follow three pages of Form 32.

9. Then shall follow eight pages of Form 33 or 34 for each matter for which a poll was

granted.

10. Then shall follow one page of Form 34A for each CSAP office to be elected.

11. Then shall follow eight pages of Form 35 for each matter for which a poll was granted.

12. Then shall follow two pages of Form 46, and the back cover.

This format may be varied by altering the number of copies of forms required to be included to

suit the circumstances of the election. Additional or loose copies of some forms also may be

used; these should be added to the poll book at the end of voting.

________________________________________________________________

Form 14A: Format of Poll Book/Plebiscite

(Section 68)

1. The cover of the poll book shall bear the subject of the election, the polling district

number, and the date of ordinary polling day.

2. The first page of the poll book shall contain Form 2.

3. Form 24 shall be on the second page, then Forms 25, 26, 26A, 27, 28, and 29 shall follow.

4. Then shall follow twelve pages of Form 30A.

5. Then shall follow three pages of Form 31.

6. Then shall follow three pages of Form 32.

7. Then shall follow eight pages of Form 33.

8. Then shall follow eight pages of Form 35A.

9 Then the back cover.

This format may be varied by altering the number of copies of forms required to be included to

suit the circumstances of the election. Additional or loose copies of some forms also may be

used; these should be added to the poll book at the end of voting.

________________________________________________________________

Form 15: Appointment of Agent (Polling Station)

(Section 71)

I, the undersigned, candidate (or the official agent of ____________________, (candidate’s name) a

candidate) for__________________________, (office) appoint the following as my (the

candidate’

s) agent with authority to represent me (the candidate) in the manner provided by the

Municipal Elections Act at Polling Station Number ________ for the election being held on

_______________, _____.

______________________________ ___________________________________

(name of agent) (address of agent)

Dated at _____________ Nova Scotia, this ______ day of _____________, ____.

_______________________________________

Signature of candidate or of official agent

________________________________________________________________

Form 16: Oath or Affirmation of Agent Representing a Candidate (Polling Station)

(Section 69)

I ______________________ the undersigned, swear (or solemnly affirm) that, at the election to

be held in the Town/Municipality/Regional Municipality of __________ on the _____ day of

___________, _____, I will not attempt, in any way, unlawfully to ascertain the candidate or

candidates for whom a voter has voted and will not in any way aid in the unlawful discovery of

the same, and that I will keep secret all knowledge which may come to me of the persons for

whom any voter has voted.

Candidate’s Name

Agent’s Signature

Sworn (or affirmed) at_____________________

in the County of ____________ this ______ day of

________________, ___________, before me

________________________________

Deputy Returning Officer

________________________________________________________________

Form 17: Appointment of Official Agent

(Section 70)

I, the undersigned, a candidate for the office of _____________________________,

(place a check mark next to the applicable statement)

_____ appoint _________________ (name) of ___________________ (address) as my official

agent with authority to represent me in the manner provided by the Municipal

Elections Act at the election being held on _________________________, _______.

_____ declare that I will act personally as official agent in the manner provided by the

Municipal Elections Act at the election being held on ________________, _______.

________________________

Signature of candidate

(A translation of this form is available in French.)

________________________________________________________________

Form 17A: Oath (or Affirmation) of Official Agent

(Section 70 )

I, _____________________________________________, the undersigned, swear (or solemnly

affirm) that as the official agent for ________________________________, a candidate in the

election to be held in the Town/Municipality/Regional Municipality of ____________________

on the __________ day of _______________________, __________, I will not attempt, in any

way, unlawfully to ascertain the candidate or candidates for whom a voter has voted or to aid in

the unlawful discovery of the same, and I will keep secret all knowledge which may come to

me of the persons for whom any voter has voted.

Sworn (or affirmed) at _________________

in the County of ______________________ _______________________________

this _____day of ________________, (Signature of Official Agent)

before me.

___________________________________

Commissioner or other Authorized Official

Municipal Elections Act , subsection [clause] 146(1)(b)

____________________________________

Print name and title

(A translation of this form is available in French.)

________________________________________________________________

Form 18: Declaration of Person Applying for a Transfer Certificate

(Section 73)

(This form [is] to be submitted to the Returning Officer before 5:00 p.m. on the

Wednesday before ordinary polling day.)

1. I am the elector whose name appears as follows in the list of electors for Polling Station

Number _________ in Polling District Number ___________ in the Town/Municipality/

Regional Municipality of _________________________________.

__________________________________________________

Number on List Name

_________________________________

Address

2. During the election I will not vote at the polling station where my name appears on the list

of electors unless I surrender the transfer certificate issued to me to the deputy returning

officer of that polling station.

3. I have not voted at the advance poll.

I request a transfer certificate to be issued to me to permit me to vote at Polling Station Number

_________ in Polling District Number _________ instead of the above polling station, because:

(place a check mark next to the applicable statement)

_____ I am a candidate, or

_____ I am an agent of a candidate who has appointed me to act at Polling Station

Number ________, where I intend to vote on election day, or

_____ I am a deputy returning officer or poll clerk who has been appointed to act at a

polling station other than where my name appears on the list of electors, or

_____ I am an assistant returning officer whose name appears on the list of electors for

a polling station other than where the headquarters of the returning officer are

situate, or

_____ I am prevented from voting at the above polling station because of physical

disability.

_________________________________

Applicant

________________________________________________________________

Form 19: Transfer Certificate (Polling Station)

(Section 73)

I certify that the elector named below is entitled under

Section 73 of the Municipal Elections Act

to a transfer certificate permitting the elector to transfer their vote from Polling Station Number

__________ to Polling Station Number ___________ and I grant this certificate so authorizing

the elector.

_______________________________ _____________________________________

Name of Elector Address

Dated this ______ day of ________________, _____.

______________________________

Returning Officer or Assistant Returning Officer

Note: Complete in triplicate.

________________________________________________________________

Form 20: Transfer Certificate (Polling District)

(Section 73)

I certify that the elector named below is entitled under

Section 73 of the Municipal Elections Act

to a transfer certificate permitting the elector to transfer their vote from Polling Station Number

_______ in Polling District Number __________ to Polling Station Number __________ in

Polling District Number ____________, and I grant this certificate so authorizing the elector to

vote for the election of ___________________________________ (specify mayor, councillor(s), CSAP,

plebiscite) .

_______________________________ _____________________________________

Name of Elector Address

Dated this _____ day of _____________, ______.

_______________________________________

Returning Officer or Assistant Returning Officer

Note: Complete in triplicate.

________________________________________________________________

Form 21: Application for a Proxy Vote

(Section 76)

(This form is to be submitted to the Returning Officer before 5:00 p.m. on Friday, the eighth day

before ordinary polling day.)

Part 1

(to be completed by elector)

I declare that:

1. I am number _________ on the list of electors for Polling Division Number _______ in

Polling District Number ________ of the Town/Municipality/Regional Municipality of

_____________________________ (the “Municipality”).

2. I am applying to vote by proxy because

(Place a check mark next to the applicable statement)

_______ I will be absent from the Municipality on the advance poll days and on ordinary

polling day.

_______ I cannot attend at the polling station because of illness or physical disability.

3. I appoint as my proxy voter _____________________________________________ who is

(state full name)

(Place check mark next to the applicable statement)

_______ an elector and whose number on the list of electors is _______for the

Town/Municipality/ Regional Municipality of _______________________.

_______ related to me as __________________________________________________

(state relationship: child/grandchild/brother/sister/parent/grandparent[/]husband/wife)

and who is an elector on the list of electors of, the Town/Municipality/Regional

Municipality of _________________________________.

( ONLY for residents of homes for the aged approved or nursing homes licensed under the

Homes for Special Care Act )

_______ related to me as __________________________________________________

(state relationship: child/grandchild/brother/sister/parent/grandparent[/]husband/wife)

and who is eighteen years of age or will as of the first advance polling day.

I declare that the above statements have been read by me or read to me and are true.

I also understand that I cannot vote in person on ordinary polling day unless I cancel the proxy

paper before five o’clock on the afternoon of Friday, the eighth day before ordinary polling day.

Dated at _____________________, this _______ day of ___________________, ________.

________________________________

Signature of the Elector

Part 2

Certificate of Proxy Voter

(to be completed by the proxy voter)

I, _________________________________________________________________, certify that:

(print name of proxy voter)

1. To the best of my knowledge, information and belief, all the information contained on the

above appointment of proxy voter is correct; and

2. (Place a check mark next to the applicable statement)

_____ I have not previously been appointed as proxy voter for any other elector during

the pending election.

_____ I have previously been appointed as proxy voter only for one other elector

during the pending election, who is not related to me, and I am related to the

elector to whom this appointment relates as ____________________________.

(state relationship: child/grandchild/brother/sister/parent/grandparent[/]husband/wife)

_____ I have previously been appointed as proxy voter during the pending election

only for:

______________________________________________________

( name and full address )

who is/are related to me as follows:

________________________________________________________________

(state relationship: child/grandchild/brother/sister/parent/grandparent[/]husband/wife)

3. I am

(Place a check mark next to the applicable statement)

_____ an elector on the list of electors for the same municipality as the elector for

whom I have been appointed as proxy voter.

( ONLY for proxy voters for residents of homes for aged approved or nursing homes

licensed under the Homes for Special Care Act )

_____ related to the elector for whom I have been appointed as proxy voter as

________________________________________________________________

(state relationship: child/grandchild/brother/sister/parent/grandparent/husband/wife)

and I am or will be eighteen years of age as of the first advance polling day.

Dated at _____________________, this _______ day of _______________________, _______.

______________________________

Signature of Proxy Voter

PLEASE READ THE FOLLOWING IMPORTANT NOTICES:

1. A person may act as proxy voter for one unrelated elector and any number of electors who

are a child, grandchild, brother, sister, parent, grandparent, husband or wife of the proxy

voter.

2. This form must be presented to the Returning Officer by the elector or proposed proxy

voter in person before five o’clock on the afternoon of Friday the eighth day before

ordinary polling day so that a Proxy Paper in Form 22 may be issued.

3. APPOINTING A PROXY VOTER MEANS THAT THE ELECTOR CANNOT

VOTE OTHER THAN BY PROXY. THIS APPLICATION FORM DOES NOT

PERMIT AN ELECTOR TO VOTE ON ELECTION DAY.

________________________________________________________________

Form 22: Number ____, Proxy Paper

(Section 76)

(NOTE: A Proxy Voter can vote only on Ordinary Polling Day.

A Proxy Voter cannot vote at any Advance Poll)

TO: The Deputy Returning Officer

Polling Station Number ________________

Polling District of _________________

I certify that:

_________________________________________________________________________

( name of elector )

of_______________________________________________________________________

( address of elector )

being number __________ on the list of electors for the above polling station may vote by

proxy by the elector’s proxy voter,

_________________________________________________________________________

( name of proxy voter )

of_______________________________________________________________________

( address of proxy voter )

Dated at _________________ this ______ day of ___________________________, _______.

______________________________

Returning Officer

________________________________________________________________

Form 23: Directions to Electors

(Section 68)

Attention Electors

Mark the ballot paper by placing a cross, an “X”, a check mark, or a line made with a pencil or

pen in the circular space on the ballot paper at the right of the name of the candidate (or names

of the candidates if more than one are to be elected) for whom you intend to vote.

Election for Councillor

Vote for no more than the number of

candidates to be elected as the case may be.

Examples:Vote for one candidate; or

Vote for no more than two candidates; or

Vote for no more than three candidates

John James JONES

Robert Simon SMITH

Sheila Elaine TURNER

Then fold and return to the Deputy Returning Officer.

A spoiled ballot may be exchanged for a new one.

WARNING: It is an offence to mark the ballot paper so that you may be identified.

________________________________________________________________

Form 23A [repealed]

________________________________________________________________

Form 24: Elector’s Oath or Affirmation of Qualification at Poll

(Section 83)

I swear (or solemnly affirm) that:

1. I am the person named (or intended to be named) _________________________________

in the list of electors now shown to me (being shown the list to the elector) and that on this

date of the poll in this election, I do actually reside in Polling Division Number _________

of the Town/Municipality/Regional Municipality of _______________________________

(the “Municipality”) and that the address of my residence is ________________________.

2. I am the full age of eighteen (18) years.

3. I am a Canadian citizen.

4. As of the first advance polling day, I have been ordinarily resident in

• the Province of Nova Scotia for a period of six (6) months; and

• in the Municipality.

5. I am not the returning officer, a person serving a sentence in a penal or reform institution,

or a person convicted of bribery under the Municipal Elections Act in the six (6) years

preceding ordinary polling day.

6. I have not voted before in this election at any polling place and will not do so or attempt to

do so and I have not received anything nor has anything been promised to me directly or

indirectly in order to induce me to vote or refrain from voting in this election.

Sworn (or affirmed) at ____________________

in the _________________________________

this ________ day of ___________________,

_________________, before me

___________________________________ ______________________________

Revising Officer Elector

________________________________________________________________

Form 24A [repealed]

________________________________________________________________

Form 25: Oath or Affirmation of Elector Requiring Assistance

(Section 86)

You swear (or solemnly affirm) that you require assistance in voting because you are blind,

unable to read or have a physical disability which prevents you from voting without assistance.

________________________________________________________________

Form 26: Oath or Affirmation of Friend of Elector Requiring Assistance (Unrelated)

(Section 86)

(For use by a person who is not a candidate and who is not related to the elector)

You swear (or solemnly affirm) that you have not previously acted as a friend for any other

elector in the election who is not a child, grandchild, brother, sister, parent, grandparent, husband

or wife, that you will carry out the wishes of the elector on whose behalf you act and that you

will keep secret the name of the candidate or candidates for whom you mark the ballot paper.

Note: A candidate may not act as friend of an elector who is not a child, grandchild,

brother, sister, parent, grandparent, husband or wife of the candidate. A person who is

not a candidate may act as friend for one unrelated elector and any number of electors

who are a child, grandchild, brother, sister, parent, grandparent, husband or wife of the

friend.

________________________________________________________________

Form 26A: Oath or Affirmation of Friend of Elector Requiring

Assistance (Candidate/Relative)

(Section 86)

(For use by a person, including a candidate, who is related to the elector)

You swear (or solemnly affirm) that the elector on whose behalf you act is a child, grandchild,

brother, sister, parent, grandparent, husband or wife, that you will carry out the wishes of the

elector and that you will keep secret the name of the candidate or candidates for whom you mark

the ballot paper.

Note: A candidate may not act as friend of an elector who is not a child, grandchild,

brother, sister, parent, grandparent, husband or wife of the candidate. A person who is

not a candidate may act as friend for one unrelated elector and any number of electors

who are a child, grandchild, brother, sister, parent, grandparent, husband or wife of the

friend.

________________________________________________________________

Form 27: Oath or Affirmation of Interpreter

(Section 87)

You swear (or solemnly affirm) that you shall well and truly interpret the questions asked of the

elector and explanations given to the elector, and the answers and questions of the elector, and

that you will keep secret any information so obtained.

________________________________________________________________

Form 28: Oath or Affirmation as to Error on List

(Section 92)

You swear (or solemnly affirm) that you believe that you are the person intended to be referred

to under the name (name as on official list of electors) whose address is given as (address as on

the official list of electors).

________________________________________________________________

Form 29: Oath or Affirmation of a Personated Elector

(Section 93)

You swear (or solemnly affirm) that you are (name as on official list of electors) of (address as

on official list of electors) whose name is entered on the list of electors now shown you, and that

you have not previously voted at this election.

Form 30: Record of Poll

(Section 94)

Order of

Voting

No. on List of

Electors/

Certificate of

Eligibility

Name of

Elector (Family

Name First)

Address

of Elector

Voted

for Mayor

Voted for

Councillor

Voted for

CSAP

Voted

for Other

Sworn or

Affirmed

Refused

to Swear

or Affirm

Transfer

Added

Proxy

Remarks (e.g.,

form of oath

taken)

Use a Check Mark

________________________________________________________________

Form 30A: Record of Poll/Plebiscite

Consecutive

No.

No. on

Voters’

List

NAME OF ELECTORS

(FAMILY NAME FIRST)

ADDRESS

Voted

Sworn or

Affirmed

Refused to

Swear or

Affirm

Transfer

Proxy

REMARKS

Note: Electors who are added at the poll do not have a number on the list of electors.

________________________________________________________________

Form 31: Oath or Affirmation of Elector Not on List of Electors on Polling Day

(Section 98)

I swear (or solemnly affirm) that:

1. On this date, I actually reside in Polling Division Number __________ of Polling District

Number _____ of the Town/Municipality/Regional Municipality of __________________

(the “Municipality”).

2. As of the first advance polling day in this election, I have been ordinarily resident in:

• the Province of Nova Scotia for a period of six (6) months; and

• the Municipality (or in an area annexed to the Municipality).

3. I have not previously voted in this election at any other polling place, and I will not (or will

not attempt to) vote at any other polling place.

4. As of the first advance polling day, I was a Canadian citizen and of the full age of eighteen

years.

5. I am not the returning officer, a person serving a sentence in a penal or reform institution, or

a person convicted of bribery under the Municipal Elections Act in the six years preceding

ordinary polling day.

Name of Elector

(please print)

Civic Address of Elector

Date of Birth

_______________________

_______________________________

_______________

_______________________

_______________________________

_______________

Sworn (or affirmed) at _________________

in the County of ______________________

this ____day of _____________,

______ before me

______________________________ _____________________________

Deputy Returning Officer Applicant

The Voters List may be used in future municipal, provincial or federal elections.

(Date of birth will be removed from final list of electors.)

________________________________________________________________

Form 31A: [repealed]

________________________________________________________________

Form 31B: Oath or Affirmation of Elector Not on List of Electors on Polling Day

(Where elector can vote only for Conseil scolaire acadien provincial )

(Section 98)

I swear (or solemnly affirm) that:

1. On this date, I actually reside in Polling Division Number ________ of the Town/

Municipality/Regional Municipality of _____________________________________ (the

“Municipality”).

2. As of the first advance polling day in this election, I have been ordinarily resident in:

• the Province of Nova Scotia for a period of six (6) months; and

• in the school region of the Municipality in which my polling division is located.

3. I have not previously voted before in this election at any other polling place, and I will not

(or will not attempt to) vote at any other polling place.

4. As of the first advance polling day, I was a Canadian citizen and of the full age of eighteen

years.

5. I am not the returning officer, a person serving a sentence in a penal or reform institution, or

a person convicted of bribery under the Municipal Elections Act in the six years preceding

ordinary polling day.

6. I wish to be added to the list of electors for the purpose of voting in this election.

Name of Elector

(please print)

Civic Address of Elector

Date of Birth

_______________________

_____________________________

________________

_______________________

_____________________________

________________

Sworn (or affirmed) at _________________

in the County of ______________________

this ____day of _____________,

______ before me

___________________________________ _____________________________

Deputy Returning Officer Applicant

(A translation of this form is available in French)

The Voters List may be used in future municipal, provincial or federal elections.

(Date of birth will be removed from final list of electors.)

________________________________________________________________

Form 31C [repealed]

Form 31D [repealed]

________________________________________________________________

Form 32: Affidavit of Proxy Voter

(Section 99)

I swear (or solemnly affirm) that,

I am the proxy voter named in the proxy paper issued to the following elector whose name

appears on the list of electors for this polling station and whose name precedes my signature:

Name of Elector

Address of Elector

Signature of Proxy Voter

Sworn (or affirmed) at __________________________

in the County of _______________________________

this _________ day of __________________________

_______________, before me

_________________________________________

Deputy Returning Officer

________________________________________________________________

Form 33: Statement of Poll (One Candidate or Matter)

(Sections 106, 111, 119)

(For use when only one candidate to be elected or one matter to be determined)

Municipality:

Polling District:

Polling Station No.:

Election for: Date:

1. Number of blank ballots received from Returning Officer

2. Add number of ballots from advance poll (if any)

3. TOTAL BALLOTS TO BE ACCOUNTED FOR *

4. Number of ballots taken from polling station (if any)

5. Number of unused ballots

6. Number of cancelled ballots (ones not placed in ballot box)

7. Number of rejected ballots (rejected during counting)

8. Number of ballots counted for ___________________

9. Number of ballots counted for ___________________

10. Number of ballots counted for ___________________

11. Number of ballots counted for ___________________

12. Number of ballots counted for ___________________

13. Number of ballots counted for ___________________

14. Number of ballots counted for ___________________

15. Number of ballots counted for ___________________

16. Number of ballots counted for ___________________

17. Number of ballots counted for ___________________

18. Number of ballots missing (if any)

19. TOTAL BALLOTS ACCOUNTED FOR *

*Note: Lines 3 and 19 must balance

Number of names on the final list of electors used at the polling

station plus electors sworn in at the polling station and added to

the list (if any)

Dated at _________________ this ________ day of _______________, ______

Approved: We certify that the above statement is correct

____________________________ _________________________________

Deputy Returning Officer

____________________________ _________________________________

Poll Clerk

________________________________________________________________

Form 34: Statement of Poll (More Than One Candidate or Matter)

(Sections 106, 111, 119)

(For use where more than one candidate is to be elected for the office or more than one matter is

to be determined from the ballot)

Municipality: _________________________________________

Polling District: _______________________________________

Polling Station No.: ____________________________________

Election for: ______________________ Date: ______________

1. __________ Number of blank ballots received from Returning Officer

2. __________ Add number of ballots from advance poll (if any)

3. *_________ TOTAL BALLOTS TO BE ACCOUNTED FOR

4. __________ Number of ballots taken from polling station (if any)

5. __________ Number of unused ballots

6. __________ Number of cancelled ballots (ones not placed in ballot box)

7. __________ Number of rejected ballots (rejected during counting)

8. __________ Number of ballot papers counted and accepted

9. __________ Number of ballot papers missing (if any)

10. *_________ TOTAL BALLOTS ACCOUNTED FOR

*Note: Lines 3 and 10 must balance

Ballots Cast For

Name of Candidate

Number of Ballots Counted

Number of names on the final list of electors used

at the polling station, plus electors sworn in at the

polling station and added to the list (if any) ___________________________________

Dated at __________________ this ________ day of ______________, ______.

Approved: We certify that the above statement is correct

___________________________ ______________________________

Deputy Returning Officer

___________________________ ______________________________

Poll Clerk

________________________________________________________________

Form 34A: Statement of Poll to be Completed when Conseil scolaire acadien provincial

Ballots to be Transferred for Counting

(Section 123A)

Municipality:

Polling District:

Polling Station No.:

Election for: Date:

1. Number of blank ballots received from Returning Officer

2. Add number of ballots from Advance Poll (if any)

3. TOTAL BALLOTS TO BE ACCOUNTED FOR *

4. Number of ballots taken from the polling station (if any)

5. Number of ballots missing (if any)

6. Number of unused ballots

7. Number of cancelled ballots (ones not placed in the ballot box)

8. Number of ballots cast at polling station for this office

(ones placed in the ballot box) ♦

9. TOTAL BALLOTS ACCOUNTED FOR *

*Note: Lines 3 and 9 must balance

10. TOTAL BALLOTS BEING TRANSFERRED ♦

♦ Note: Lines 8 and 10 must balance

Dated at _______________ , this ____ day of ______________ , _______.

Approved: We certify that the above statement is correct

___________________________ ______________________________

Deputy Returning Officer

___________________________ ______________________________

Poll Clerk

________________________________________________________________

Form 35: Tally Sheet For the Counting of Votes

(Section 107)

To be used by the Deputy Returning Officer or the poll clerk and the candidates’ agents at the

counting of the votes cast for the various candidates on polling day. A cross or check mark of

any kind will be made consecutively in the small squares under the name of the candidate, in the

appropriate column, as each vote is called out by the Deputy Returning Officer.

Column of

Votes Cast for

......................

(name of

Candidate)

Column of

Votes Cast for

.......................

(name of

Candidate)

Column of

Votes Cast for

.......................

(name of

Candidate)

Column of

Votes Cast for

......................

(name of

Candidate)

Column of

Votes Cast for

........................

(name of

Candidate)

Column of

Votes Cast for

......................

(name of

Candidate)

Column of

Votes Cast for

........................

(name of

Candidate)

________________________________________________________________

Form 35A: Tally Sheet for the Counting of Votes/Plebiscite

(Section 107)

To be used by the Deputy Returning Officer or the poll clerk at the counting of the votes cast for

the plebiscite on polling day. A cross or check mark of any kind will be made consecutively in

the small squares under the question number, in the appropriate column, as each vote is called

out by the Deputy Returning Officer.

Column of

Votes Cast for

....... YES ........

Column of

Votes Cast for

...... NO .......

________________________________________________________________

Form 36: Tally Sheet for the Counting of Votes At a Plebiscite

(Section 107)

To be used by the Deputy Returning Officer or the poll clerk and the candidates’ agents at the

counting of the votes cast for a plebiscite on polling day. A cross or check mark of any kind will

be made consecutively in the small squares under the question number, in the appropriate

column, as each vote is called out by the Deputy Returning Officer.

Column of

....... YES ........

Column of

...... NO .......

Column of

..... YES ....

Column of

..... NO .....

________________________________________________________________

Form 37: Persons Who Have Voted at the Advance Poll

(Section 117)

Advance Polling Station _______ comprising Policing [Polling] Division Numbers

__________________ to ___________________________.

Name of Elector

Polling Division

Number

Elector’s

Number on List

The number of electors who voted in this polling station s is ___________________.

Dated at ____________________________ this _________ day of

____________________________, ______.

______________________________________________

Deputy Returning Officer

________________________________________________________________

Form 38: Recapitulation Sheet

(Section 128)

Recapitulation Sheet

Note: “Rejected Ballots” are only those cast but not counted. Do not enter cancelled ballots on this sheet

POLLING STATION

Number of

Names on

Final

List of

Electors

plus

Electors

added to

the List

BALLOTS CAST FOR CANDIDATES

Names of Candidates

Rejected

Ballots

Number

Polling

Division

Name

Number of

Polling

District

Location of Polling

Station

Total

I certify that the foregoing statement is the correct result of the polling at the election held on the

____________________ day of ____________________, 20_______

Dated at ______________________________ this _______________ day of _______________, 20_______

Sheet Number ________________

______________________________________

Returning Officer

________________________________________________________________

Form 38A [repealed]

________________________________________________________________

Form 39: Council Member’s Oath of Allegiance and of Office

(Section 147)

I, ____________________________, swear (or solemnly affirm) that I will be faithful and bear

true allegiance to His Majesty King Charles the Third, His heirs and successors according to law;

(the name of and reference to the sovereign to be changed as occasion requires.)

And that I am duly qualified as required by law for the office of ________________ of the

________________ of ________________;

And that I will truly, faithfully and impartially execute the duties of the office to which I have

been elected to the best of my knowledge and ability;

And that I have not received and will not receive any payment or reward or promise thereof for

the exercise of any partiality or other undue execution of the duties of my office.

Sworn (or affirmed) at ________________

in the County of _____________________

this _____ day of ____________________,

_______, before me

__________________________________

Judge, Justice of the Peace

(or for council members, also Mayor, Warden or Clerk)

________________________________________________________________

Form 40: Candidate’s Campaign Contributions Disclosure Statement

(Sections 49A and 49B)

Name of Candidate: ____________________________________________________________

Name of Agent: ________________________________________________________________

Date of Election: ______________ Municipality/CSAP: __________________________

☐ I received no contributions from a contributor that totalled more than $50.00 during the

period since the previous election.

☐ I received the following contributions from a contributor that totalled more than $50.00

during the period since the previous election.

List of contributors (see note below):

Contributor Civic Address Contributions

________________________ _______________________ _______________________

Note: Insert full name of contributor and residential or business address. Use street

address, not postal address. Contributions must be shown for every contributor whose

contributions totalled more than $50.00 since the most recent election.

I, _________________________________, a candidate in the municipal/CSAP election on

__________________ (date) , certify that the foregoing statement of disclosure is a true and

complete disclosure of all contributions made to me and to my official agent as required by

Sections 49A and 49B of the Municipal Elections Act .

_____________________________________

Candidate

( To be filed within 60 days after regular polling day with the clerk of the municipality/secretary

of CSAP )

(A translation of this form is available in French.)

________________________________________________________________

Form 41: Association’s Campaign Contributions Disclosure Statement

(Sections 49A and 49B)

Name of Association: _____________ ______________________________________________

Name of agent: ________________________________________________________________

Name of candidate supported: _____________________________________________________

Date of election: _____________ Municipality/CSAP: ___________________________

☐ The above-named candidate received no contributions from a contributor that totalled more

than $50.00 during the period since the previous election.

☐ The candidate received the following contributions from a contributor that totalled more

than $50.00 during the period since the previous election.

List of contributors (see note below):

Contributor Civic Address Contributions

________________________ _______________________ _______________________

Note: Insert full name of contributor and residential or business address. Use street

address, not postal address. Contributions must be shown for every contributor whose

contributions totalled more than $50.00 since the most recent election.

I, _______________________________, the appointed agent of _________________________

(name of association) in the municipal/CSAP election on __________________ (date) , certify that the

foregoing statement of disclosure is a true and complete disclosure of all contributions made to

me as agent of the said association as required by Sections 49A and 49B of the Municipal

Elections Act .

_____________________________________

Agent of Association

( To be filed within 60 days after regular polling day with the clerk of the municipality/secretary

of CSAP )

(A translation of this form is available in French.)

________________________________________________________________

Form 42 [repealed]

Form 43 [repealed]

________________________________________________________________

Form 44: Statement of Poll, Consolidated Count of Conseil scolaire acadien provincial Ballots

(One Member to be Elected from the CSAP Electoral District)

(Section 123A)

(For use when the ballots from polls with fewer than 10 votes for a CSAP

office are counted by a counting officer)

CSAP Electoral District

Number of Polls to be Counted (# of envelopes to be opened and counted)

1. Total Number of Ballots to be Counted

(from endorsements on each envelope from

each polling station) *

2. Number of Rejected Ballot Papers

3. Number of Ballot Papers Counted and Accepted

4. Number of Ballot Papers Missing (if any)

(#1 minus #3)

5. Additional Ballot Papers (if any)

(#3 minus #1)

6. Total Ballots to be Accounted for *

(Note: Lines 1 and 6 must balance.)

7. Number of Ballots counted for

Number of Ballots counted for

8. TOTAL BALLOTS ACCOUNTED FOR *

(Note: Lines 6 and 8 must balance.)

Dated at _________________, this _______ day of _____________, ______.

Approved I certify that the above statement is correct

__________________________________

Counting Officer

________________________________________________________________

Form 45: Statement of Poll, Consolidated Count of Conseil scolaire acadien provincial Ballots

(More than One Member to be Elected from the CSAP Electoral District)

(Section 123A)

(For use when the ballots from polls with fewer than 10 votes for a CSAP

office are counted by a counting officer)

CSAP Electoral District

Number of Polls to be Counted (# of envelopes to be opened and counted)

1. Total Number of Ballots to be Counted

(from endorsements on each envelope from each

polling station) *

2. Number of Rejected Ballot Papers

3. Number of Ballot Papers Counted and Accepted

4. Number of Ballot Papers Missing (if any)

(#1 minus #3)

5. Additional Ballot Papers (if any)

(#3 minus #1)

6. Total Ballots to be Accounted for *

(Note: Lines 1 and 6 must balance.)

7. Names of Candidates Number of Ballots (Votes)

8. TOTAL BALLOTS ACCOUNTED FOR *

(Note: Lines 6 and 8 must balance.)

Dated at _________________, this _______ day of _____________, ______.

Approved I certify that the above statement is correct

Counting Officer

________________________________________________________________

Form 46: Record of Objections

(Section 109)

No.

Objections Made

On Behalf of

(Name of Candidate)

Nature of Objection

How

Decided

Legislative History

Reference Tables

Municipal Elections Act Forms

N.S. Reg.

84/1997

Municipal Elections Act

Note: The

information in these tables does not form part of the regulations and is

compiled by the Office of the Registrar of Regulations for reference only.

Source Law

The current consolidation of the Municipal Elections Act Forms made under the Municipal Elections Act includes all of the following

regulations:

N.S.

Regulation

In force

date*

How in force

Royal Gazette

Part II Issue

84/1997

Jul

15, 1997

date

made

Aug 1,

37/1999

Mar

25, 1999

date

made

May 7,

105/1999

Oct 7,

date

made

Nov 5,

130/2000

Jul

11, 2000

date

made

Jul

28, 2000

142/2000

Aug 8,

date

made

Sep 8,

1/2003

Jan

14, 2003

date

made

Feb 7,

137/2003

Jul

25, 2003

date

made

Aug

22, 2003

182/2004

Jul 7,

date

made

Aug 6,

55/2006

Apr

12, 2006

date

made

Apr

28, 2006

304/2008

Jun

16, 2008

date

specified

Jul 4,

323/2008

Jul

10, 2008

date

specified

Aug 1,

105/2012

May

10, 2012

date

specified

Jun 1,

78/2016

Apr

15, 2016

date

specified

May

13, 2016

127/2016

Jun

21, 2016

date

specified

Jul 8,

135/2024

Jul 5,

date

specified

Jul

26, 2024

176/2024

Aug

15, 2024

date

specified ( date that S.N.S. 2023, c. 10 came into force on proclamation )

Sep 6,

The following regulations are not

yet in force and are not included in the current consolidation:

N.S.

Regulation

In force

date*

How in force

Royal Gazette

Part II Issue

*See subsection 3(6) of the Regulations Act for

rules about in force dates of regulations.

Amendments by Provision

ad. = added

am. = amended

fc. = fee change

ra. = reassigned

rep. = repealed

rs. = repealed and substituted

Provision affected

How affected

Form 1 ..............................................

am. 182/2004

Form 2 ..............................................

am. 182/2004

Form 3 ..............................................

rs. 137/2003, 182/2004, 304/2008, 135/2024

Form 4 ..............................................

am. 182/2004

Form 5 ..............................................

am. 182/2004

Form 6 ..............................................

rs. 130/2000, 182/2004, 304/2008

Form 6A ...........................................

rs. 130/2000, 182/2004, 304/2008

Form 8 ..............................................

rs. 130/2000, 182/2004, 78/2016

Form 8A ...........................................

rep. 130/2000

Form 8B ............................................

rep. 130/2000

Form 8C ............................................

rep. 130/2000

Form 9 ..............................................

rs. 130/2000; am. 182/2004; rs. 78/2016, 135/2024

Form 9A ...........................................

rep. 130/2000

Form 10 ............................................

am. 137/2003

Form 10A .........................................

ad. 137/2003; rs.

182/2004, 304/2008, 105/2012; rep. 78/2016

Form 10B ..........................................

ad. 137/2003 ; rep. 78/2016

Form 11 ............................................

rs. 105/1999, 130/2000; am. 137/2003, 182/2004; rs.

304/2008, 78/2016, 135/2024

Form 11A .........................................

rs. 105/1999, 130/2000; am. 137/2003, 182/2004; rs.

304/2008, 323/2008, 78/2016; rep. 135/2024

Form 11B ..........................................

rs. 105/1999, 130/2000, 142/2000; am. 137/2003, 182/2004;

rs. 304/2008, 78/2016, 135/2024, 176/2024

Form 11C ..........................................

rs. 130/2000; am. 137/2003, 182/2004; rs. 304/2008, 323/2008,

78/2016; rep. 135/2024

Form 12 ............................................

rs. 130/2000; am. 137/2003, 182/2004; rs. 304/2008

Form 12A .........................................

ad. 182/2004

Form 13A .........................................

ad. 1/2003 ; rs. 55/2006 1

Form 14 ............................................

rs. 130/2000; rs. 182/2004, 55/2006, 304/2008, 135/2024

Form 14A .........................................

ad. 55/2006

Form 15 ............................................

rs.

135/2024

Form 16 ............................................

rs.

135/2024

Form 17 ............................................

rs. 105/1999, 130/2000, 182/2004

Form 17A .........................................

ad. 105/2012

Form 18 ............................................

rs. 304/2008, 105/2012

Form 19 ............................................

rs. 135/2024

Form 20 ............................................

rs. 130/2000, 323/2008, 135/2024

Form 21 ............................................

rs. 137/2003; am. 182/2004; rs. 304/2008, 105/2012, 78/2016

Form 22 ............................................

am. 137/2003; rs. 304/2008, 78/2016, 135/2024

Form 23 ............................................

am. 182/2004; rs. 304/2008, 105/2012

Form 23A .........................................

rs. 55/2006; rep. 323/2008

Form 24 ............................................

rs. 78/2016

Form 24A .........................................

rep. 130/2000

Form 26 ............................................

rs. 137/2003

Form 26A .........................................

ad. 137/2003

Form 27 ............................................

rs.

135/2024

Form 30 ............................................

rs. 105/1999, 130/2000; am. 137/2003; rs. 323/2008, 135/2024

Form 30A .........................................

ad. 55/2006

Form 31 ............................................

rs. 130/2000, 182/2004, 304/2008, 78/2016

Form 31A .........................................

rs. 130/2000; am. 137/2003; rs. 182/2004, 304/2008,

323/2008, 78/2016; rep. 135/2024

Form 31B ..........................................

rs. 130/2000; am. 137/2003; rs. 182/2004, 304/2008, 78/2016

Form 31C ..........................................

rep. 130/2000

Form 31D .........................................

rep. 130/2000

Form 32 ............................................

am. 137/2003; rs. 78/2016

Form 33 ............................................

rs. 130/2000

Form 34 ............................................

rs. 130/2000, 304/2008

Form 34A .........................................

ad. 130/2000 ; am. 182/2004;

rs. 135/2024

Form 34B ..........................................

rep. 304/2008

Form 35 ............................................

rs. 304/2008, 105/2012

Form 35A .........................................

ad. 55/2006

Form 36 ............................................

rep. 137/2003

Form 36 ............................................

ad. 304/2008 2

Form 37 ............................................

am. 137/2003, rs. 127/2016

Form 38 ............................................

rs. 130/2000, 304/2008, 105/2012

Form 38A .........................................

ad. 55/2006 ; rep. 304/2008

Form 39 ............................................

rs. 130/2000, 135/2024

Form 40 ............................................

ad. 37/1999 ; am.

182/2004; rs. 78/2016, 135/2024

Form 41 ............................................

ad. 37/1999 ; am.

182/2004; rs. 78/2016, 135/2024

Form 42 ............................................

ad. 130/2000; rep. 137/2003

Form 43 ............................................

ad. 130/2000; rep. 137/2003

Form 44 ............................................

ad. 130/2000 ; rs.

135/2024

Form 45 ............................................

ad. 130/2000 ; rs.

135/2024

Form 46 ............................................

ad. 182/2004

Note that changes to headings are not

included in the above table.

Editorial Notes and Corrections

Note

Effective

date

Amending instruction in N.S. Reg. 55/2006 adds Form

13A, but Form 13A already exists. Form 13A repealed and substituted for the

purposes of this consolidation.

Amending instruction in N.S. Reg. 304/2008 repeals and

substitutes Form 36, but Form 36 is already repealed. Form 36 added for the purposes

of this consolidation.

Repealed and Superseded

N.S.

Regulation

Title

In force

date

Repealed

date

82/1991

Municipal Elections Forms

Apr 23, 1991

Aug 3, 1994

127/1994

Municipal Elections Forms

Aug 3, 1994

Jul 15, 1997

Note: Only regulations

that are specifically repealed and replaced appear in this table. It may not reflect the entire history of

regulations on this subject matter.

Document details

Collection	Nova Scotia — Regulations
Citation	N.S. Reg. 84/1997
Date	1997-01-01
Type	regulation
Volume / chapter	just regulations regs melforms.htm
Language	en
Format	htm
Source	PROVINCIAL
Identifier	159c0ced8e254a7e304aabe6b379eec6a61abf71

Source file is stored in the law ingest library (htm).

these regulations (N.S. Reg. 84/1997) (just regulations regs melforms.htm)

Part II .

Table of Contents

Section 146) Returning Officer/Assistant Returning Officer/Revising

Section 146) Deputy Returning Officer/Poll Clerk

Section 146) Registrar of Voters

Section 146) Enumerator

Section 146) and the authorization is attached)

Section 146) and the authorization is attached)

Section 146) Candidate (or Official Agent if authorized and

(TO BE FILED WITHIN 7 DAYS AFTER ELECTION DAY)

FRONT

FRONT

Section 73 of the Municipal Elections Act

Section 73 of the Municipal Elections Act

Part 1

Part 2

PLEASE READ THE FOLLOWING IMPORTANT NOTICES:

3. APPOINTING A PROXY VOTER MEANS THAT THE ELECTOR CANNOT

VOTE OTHER THAN BY PROXY. THIS APPLICATION FORM DOES NOT

PERMIT AN ELECTOR TO VOTE ON ELECTION DAY.

NAME OF ELECTORS

(FAMILY NAME FIRST)

ADDRESS

REMARKS

3. TOTAL BALLOTS TO BE ACCOUNTED FOR *

19. TOTAL BALLOTS ACCOUNTED FOR *

3. *_________ TOTAL BALLOTS TO BE ACCOUNTED FOR

10. *_________ TOTAL BALLOTS ACCOUNTED FOR

3. TOTAL BALLOTS TO BE ACCOUNTED FOR *

9. TOTAL BALLOTS ACCOUNTED FOR *

10. TOTAL BALLOTS BEING TRANSFERRED ♦

....... YES ........

...... NO .......

....... YES ........

...... NO .......

..... YES ....

..... NO .....

POLLING STATION

BALLOTS CAST FOR CANDIDATES

Division

8. TOTAL BALLOTS ACCOUNTED FOR *

8. TOTAL BALLOTS ACCOUNTED FOR *

Part II Issue

Part II Issue

Document details