E-6.01 Reg 2 - The Election Forms (Chief Electoral Officer) … · 2020-02-25 · 3 ELECTION FORMS...
Transcript of E-6.01 Reg 2 - The Election Forms (Chief Electoral Officer) … · 2020-02-25 · 3 ELECTION FORMS...
1ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
The Election Forms (Chief
Electoral Officer) Regulations
Repealedby Saskatchewan Regulations 6/2020
(effective January 31, 2020).
FormerlyChapter E-6.01 Reg 2 (effective December 19, 1997) amended by Saskatchewan Regulation 47/2001, 6/2006 and 85/2014.
NOTE:This consolidation is not official. Amendments have been incorporated for convenience of reference and the original statutes and regulations should be consulted for all purposes of interpretation and application of the law. In order to preserve the integrity of the original statutes and regulations, errors that may have appeared are reproduced in this consolidation.
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E-6.01 REG 2 Table of Contents
1 Title2 Interpretation3 Forms prescribed4 Coming into force
Appendix
FormsForm E Petition for Registration of a Political Party
Form F Writ of Election
Form G Oath or Declaration of Returning Officer
Form H Appointment of Election Clerk
Form I Oath or Declaration of Election Clerk
Form J Affidavit of Printer
Form K Affidavit to be Made by Returning Officer after Sending his or her Return to the Chief Electoral Officer
Form L Notice of Request for Recount or Addition
Form M Certificate of Returning Officer (Recount or Addition)
Form N Appointment of Enumerator by Returning Officer
Form O Oath or Declaration of Enumerator
Form P Appointment of Deputy Returning Officer
Form Q Oath or Declaration of Deputy Returning Officer
Form R Appointment of Supervisory Deputy Returning Officer
Form S Oath or Declaration of Supervisory Deputy Returning Officer
Form T Appointment of Poll Clerk
Form U Oath or Declaration of Poll Clerk
Form V Oath or Declaration of Interpreter
Form W Oath or Declaration of Secrecy
Form X Oath or Declaration of Inability to Mark Ballot Paper
Form Y Oath or Declaration of Friend of Voter
Form Z Oath or Declaration of Poll Clerk after Closing of the Polling Place for Voting
Form AA Oath or Declaration of Deputy Returning Officer after Closing of the Polling Place for Voting
Form BB Receipt for Ballot Box
Form CC Oath or Declaration of Messenger who Delivers the Ballot Box to the Returning Officer
Form DD Declaration of Voter
Form EE Ballot Paper Account and Poll Statement
Form FF Ballot Template
Form GG Notice to Voters – Northern Constituencies
Form HH Directions for the Guidance of VotersForm II Notice as to Secrecy of VotingForm JJ Statement by Deputy Returning Officer
Respecting Voters who Made the Declaration on Election Day
Form KK Voters who Voted at Advance Poll or Mobile Poll
Form LL Voters’ ListForm MM Certificate of Returning OfficerForm NN Certificate of Revision
Form OO Absentee Voter Application
Form PP Certificate Envelope
Form QQ Outer Envelope to the Returning Officer
Form RR Statement of Ballots Mailed or Delivered to the Returning Officer
Form SS Nomination Paper
Form TT Certificate Respecting Nomination Paper and Deposit
Form UU Withdrawal of Candidate
Form VV Candidate’s Return of Election Expenses
Form WW Oath or Declaration of Business Manager of a Candidate
Form XX Candidate’s Oath or Declaration as to Expenses
Form YY Summary of Candidate Election Expenses
Form ZZ Registered Political Party’s Return of Election Expenses
Form AAA Oath or Declaration of a Chief Official Agent of a Registered Political Party
Form BBB Registered Political Party’s Fiscal Period Return
Form CCC Statement Respecting Election Programs, Advertisements and Announcements
Form DDD Certificate of the Returning Officer (Number of Voters on Official Voters’ List)
Form EEE Poll Book
Form FFF Oath or Declaration of a Chief Official Agent of a Registered Political Party
Form GGG
Form HHH Application to Chief Electoral Officer for Registration of a Political Party
Form III Homebound Voter Application and Declaration
Form JJJ Certificate Envelope
Form KKK Statement of Homebound Voters’ Ballots Delivered to the Returning Officer
Form LLL Poll Book (Homebound Voters)
Form MMM Application for Revision
Form NNN Application to Access Information in Register of Voters
Form OOO Enumeration/Registration at a Poll
3ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
CHAPTER E-6.01 REG 2The Election Act, 1996
Title1 These regulations may be cited as The Election Forms (Chief Electoral Officer) Regulations.
Interpretation2 In these regulations:
(a) “Act” means The Election Act, 1996;
(b) “Form” means a form as set out in the Schedule to these regulations.2 Jan 98 cE-6.01 Reg 2 s2.
Forms prescribed3 For the purposes of the Act: [note that Forms A to D were prescribed in The Election Regulations, being chapter E-6.01 Reg 1 of The Revised Regulations of Saskatchewan]
(a) Form E is prescribed as the form for registering a political party;
(b) Form F is prescribed as the form for the Writ of Election;
(c) Form G is prescribed as the form for the oath or declaration of a returning officer;
(d) Form H is prescribed as the form for the appointment of an election clerk;
(e) Form I is prescribed as the form for the oath or declaration of an election clerk;
(f) Form J is prescribed as the form for the affidavit of a printer;
(g) Form K is prescribed as the form for the affidavit made by a returning officer after sending his or her return to the chief electoral officer;
(h) Form L is prescribed as the form for a notice of request for a recount or addition;
(i) Form M is prescribed as the form for a certificate of a returning officer respecting a recount or addition;
(j) Form N is prescribed as the form for appointment of an enumerator by a returning officer;
(k) Form O is prescribed as the form for the oath or declaration of an enumerator;
(l) Form P is prescribed as the form for appointment of a deputy returning officer;
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(m) Form Q is prescribed as the form for the oath or declaration of a deputy returning officer;
(n) Form R is prescribed as the form for appointment of a supervisory deputy returning officer;
(o) Form S is prescribed as the form for the oath or declaration of a supervisory deputy returning officer;
(p) Form T is prescribed as the form for appointment of a poll clerk;
(q) Form U is prescribed as the form for the oath or declaration of a poll clerk;
(r) Form V is prescribed as the form for the oath or declaration of an interpreter;
(s) Form W is prescribed as the oath or declaration of secrecy required for the purposes of section 14 of the Act;
(t) Form X is prescribed as the oath or declaration of inability to mark a ballot paper for the purposes of sections 77 and 78 of the Act;
(u) Form Y is an oath or declaration of a friend of a voter for the purposes of sections 77 and 78 of the Act;
(v) Form Z is prescribed as the oath or declaration of a poll clerk after the closing of the polling place for voting;
(w) Form AA is prescribed as the oath or declaration of a deputy returning officer after the closing of the polling place for voting;
(x) Form BB is prescribed as the form for the receipt for a ballot box to be made by a deputy returning officer for the purposes of section 93, 100, 108, 116, 126, 135 and 143 of the Act;
(y) Form CC is prescribed as the oath or declaration of a messenger who delivers a ballot box to a returning officer;
(z) Form DD is prescribed as the form for a declaration of a voter;
(aa) Form EE is prescribed as the form for the ballot paper account and poll statement;
(bb) Form FF is prescribed as the form for the ballot template;
(cc) Form GG is prescribed as the form for the notice to voters in northern constituencies, as defined in section 136 of the Act;
(dd) Form HH is prescribed as the form for the directions for the guidance of voters;
(ee) Form II is prescribed as the form of notice as to the secrecy of voting;
(ff) Form JJ is prescribed as the form for the statement by a deputy returning officer respecting voters who made the voter’s declaration on election day;
(gg) Form KK is prescribed and the form for the list of voters who voted at an advance poll or mobile poll;
5ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
(hh) Form LL is prescribed as the form for the voters’ list;
(ii) Form MM is prescribed as the form for the certificate of an enumerator;
(jj) Form NN is prescribed as the form prescribed as the certificate of revision of a voters’ list;
(kk) Form OO is prescribed as the form for an application to be considered as an absentee voter and to vote pursuant to section 87 of the Act;
(ll) Form PP is prescribed as the form for the certificates to be completed with respect to absentee voters pursuant to section 88 of the Act;
(mm) Form QQ is prescribed as the form to be used on the outer envelope of an absentee voter pursuant to section 88 of the Act;
(nn) Form RR is prescribed as the form for the statement of absentee voters ballots mailed or delivered to a returning officer;
(oo) Form SS is prescribed as the form for a nomination paper;
(pp) Form TT is prescribed as the certificate of a returning officer respecting the filing of a nomination paper and deposit;
(qq) Form UU is prescribed as the form for a withdrawal of a candidate;
(rr) Form VV is prescribed as the form for the return of a candidate’s election expenses;
(ss) Form WW is prescribed as the form for the oath or declaration of a candidate’s business manager required pursuant to clause 261(1)(c) of the Act;
(tt) Form XX is prescribed as the form for the oath or declaration of a candidate respecting the candidate’s election expenses required pursuant to subsection 261(4) of the Act;
(uu) Form YY is prescribed as the form for the summary of a candidate’s election expenses;
(vv) Form ZZ is prescribed as the form of return to be made by a registered political party respecting is election expenses pursuant to section 251 of the Act;
(ww) Form AAA is prescribed as the form for the oath or declaration of the chief official agent of a registered political party respecting its election expenses and required pursuant to clause 251(1)(c) of the Act;
(xx) Form BBB is prescribed as the form for the annual return of a registered political party required pursuant to section 250 of the Act;
(yy) Form CCC is prescribed as the statement respecting election programs, advertisements and announcements required by a broadcaster or publisher of a newspaper, magazine or periodical pursuant to section 279 of the Act;
(zz) Form DDD is prescribed as the form for the certificate of the returning officer respecting the number of voters on the official voters’ list pursuant to section 252 of the Act;
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(aaa) Form EEE is prescribed as the form of the poll book pursuant to section 5 of the Act;
(bbb) Form FFF is prescribed as form for the oath or declaration of the chief official agent of a registered political party pursuant to section 250 of the Act.
(ccc) Form GGG is prescribed as the form to be used for the purposes of section 5 of the Act;
(ddd) Form HHH is prescribed as the form to be used for the purposes of applying to the Chief Electoral Officer for registration of a political party;
(eee) Form III is prescribed as the form to be used for the purposes of an application to be considered as a homebound voter pursuant to subsection 89.2(1) of the Act;
(fff) Form JJJ is prescribed as the form to be used for the certificate to be completed with respect to absentee voters pursuant to section 89.3 of the Act;
(ggg) Form KKK is prescribed as the form for the statement of homebound voters’ ballots mailed or delivered to a returning officer;
(hhh) Form LLL is prescribed as the form of the poll book record to be used to contain the names of persons who have voted as homebound voters;
(iii) Form MMM is prescribed as the form to be used by an applicant for revision of the preliminary voters’ list pursuant to section 29.1 of the Act;
(jjj) Form NNN is prescribed as the form to be used for the purposes of an application to access information in the register of voters pursuant to section 18.6 of the Act;
(kkk) Form OOO is prescribed as the form to be used to record collected voter data during an enumeration pursuant to section 22 of the Act.
2 Jan 98 cE-6.01 Reg 2 s3; 17 Feb 2006 SR6/2006 s3; 31 Oct 2014 SR 85/2014 s3.
Coming into Force4 These regulations come into force on the day on which they are filed with the Registrar of Regulations.
2 Jan 98 cE-6.01 Reg 2 s4.
7ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
Appendix
FORM E[Section 224 of the Act]
Petition for Registration of a Political Party
We, the undersigned residents of Saskatchewan:
1. petition to the Chief Electoral Officer of Saskatchewan in support of an application for the registration of_____________________________________________________ , a political party, pursuant to the provisions ofsubsection 224(2) of The Election Act, 1996.
2. severally declare, each for himself or herself, that:
(a) we are Canadian citizens or British subjects other than Canadian citizens who were qualified asvoters on June 23, 1971;
(b) we are of the full age of 18 years;
(c) we have ordinarily resided in Saskatchewan for at least six months immediately preceding the daywe signed this petition;
(d) we are not disqualified from voting pursuant to section 17 of The Election Act, 1996;
(e) we reside in the constituency indicated beside our signatures; and
(f) we have each signed this petition only once.
Name Land Location – Rural or Post Office SignatureDate of Voter Street and Number – Cities and Towns Address Constituency of Voter
NOTE: In order for this petition to be valid it must be signed by not fewer than 2,500 voters, 1,000 ofwhom must reside in at least 10 different constituencies, with a minimum of 100 voters in each ofthose constituencies.
2 Jan 98 cE-6.01 Reg 2.
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FORM F[Sections 31, 32 and 33 of the Act]
Writ of ElectionCanada:Province of Saskatchewan.
Elizabeth the Second, by the Grace of God of the United Kingdom, Canada and Her other Realms and Territories,Queen, Head of the Commonwealth, Defender of the Faith.
To _____________________________________________ of ___________________________________________________in the Province of Saskatchewan, greeting:
We command you that you do cause:
(a) an election to be held according to law of a member to serve in the Legislative Assembly of Saskatchewan forthe constituency of ________________________________________________________________________________;
(b) the nomination of candidates at the election to be held on ____________________________________________the ________________ day of ___________ next;
(c) the voting of voters to be held, if required, on _______________________________________________________the _________________ day of ______________________ ;
(d) if voting of voters is required, an advance poll to be held on the following days in the afternoon during thehours mentioned:
____________________ the _______ day of _______________ , _______ , from ____ o’clock to ____ o’clock;
____________________ the _______ day of ______________ , _______ , from ____ o’clock to ____ o’clock;
____________________ the _______ day of ______________ , _______ , from ____ o’clock to ____ o’clock;
____________________ the _______ day of ______________ , _______ , from ____ o’clock to ____ o’clock;
____________________ the _______ day of ______________ , _______ , from ____ o’clock to ____ o’clock;
(e) the number of votes cast for the several candidates to be added up on _________________________________the _____________ day of _____________________ ;
(f) a return to the writ to be made on _________________________ the ___________ day of _________________.
In testimony whereof, we have caused these our letters to be made patent and the Great Seal of Saskatchewan tobe affixed.
Witness our trusty and well beloved, the Honourable _____________________________________________________,Lieutenant Governor of the Province of Saskatchewan at the City of Regina this ____________________________day of _____________________________________ in the _________________ year of our reign and the year of ourLord ___________________________ .
By order,(Seal)
______________________________________________________Signature of Chief Electoral Officer
Endorsement
Received this writ on ___________________ , being the _______ day of ______________ , ___________ .
______________________________________________________Signature of Returning Officer
2 Jan 98 cE-6.01 Reg 2.
9ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
FORM G[Sections 9 and 12 of the Act]
Oath or Declaration of Returning Officer
I, ___________________________________________________________________________ , returning officer for the
constituency of _____________________________________________________________________________________ ,swear (or solemnly affirm):
1. That I am legally qualified to act as returning officer for this constituency, and that I will act faithfully inthat capacity, without partiality, fear, favour or affection;
2. That I will not attempt to ascertain and will by every means in my power prevent any other person fromascertaining how any person is about to vote or has voted at this election;
3. That I will not communicate to any person any information of any kind that may enable or assist anyperson to ascertain the candidate for whom any person has voted;
4. That I will in all respects maintain and aid in maintaining the absolute secrecy of the voting.
(So help me God.)(if sworn)
Sworn (or solemnly affirmed) before me at the _____________of _______________________ in the Province of Saskatchewan Signature of Returning Officerthis ___________ day of________________________ , ________ .
_________________________________________________________A Commissioner, etc. (or as the case may be)
}
2 Jan 98 cE-6.01 Reg 2.
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FORM H[Section 12 of the Act]
Appointment of Election Clerk
, :oTnoitapuccO emaN
of Residential Address
In my capacity of Chief Electoral Officer of Saskatchewan
I appoint you to be Election Clerk, to act in that capacity at the approaching election for the said
constituency of .
Given under my hand this day of , .
Signature of Chief Electoral Officer
31 Oct 2014 SR 85/2014 s5.
FORM I[Section 12 of the Act]
Oath or Declaration of Election Clerk
I, _____________________________________________________________________ , appointed election clerk for the
constituency of ______________________________________________________________________________________ ,swear (or solemnly affirm) that I am legally qualified to act as election clerk and that I will act faithfully in thatcapacity and also in that of returning officer if required to act in that capacity without partiality, fear, favour oraffection.
(So help me God.)(if sworn)
Sworn (or solemnly affirmed) before me at the _____________ _______________________________of _______________________ in the Province of Saskatchewan Signature of Election Clerkthis ___________ day of _______________________ , ________ .
_________________________________________________________A Commissioner, etc. (or as the case may be)
}
2 Jan 98 cE-6.01 Reg 2.
11ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
FORM J[Sections 35, 96, 104 and 112 of the Act]
Affidavit of Printer
Constituency of ________________________________________________________________________________________
I, ___________________________________________________________________________ , swear (or solemnly affirm):
1 That _____________ sheets for ballot papers numbered as follows, namely _____________________________ ,were delivered to me by the returning officer of the above-mentioned constituency for the printing of thoseballot papers, which were printed for use at the election to be held on the ________________________ day of________________________ , ______________, and each of the sheets was cut into ______________________
ballot papers;
2 That the number of ballot papers properly printed and delivered to the returning officer in Form A was____________________ , and in Form B was _____________ , and that no other ballot papers have been
supplied to any other person;
3 That ____________ sheets numbered as follows, namely, _____________________________________________ ,were not required and have been returned to the returning officer in the condition in which they werereceived;
4 That ____________ sheets of ballot papers were spoiled in printing and that every piece of spoiled ballotpaper has been returned to the returning officer; and
5 That, the ballot papers having been printed, the cut-off portions of all the sheets out of which ballot paperswere cut have been arranged in numerical order according to the numbers printed and returned to thereturning officer for return to the Chief Electoral Officer.
Sworn (or solemnly affirmed) before me at the _____________ _______________________________of _______________________ in the Province of Saskatchewan Signature of Printerthis ___________ day of________________________ , ________ .
_________________________________________________________A Commissioner, etc. (or as the case may be)
}
2 Jan 98 cE-6.01 Reg 2.
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FORM K[Section 172 of the Act]
Affidavit to be Made by Returning Officer after Sendinghis or her Return to the Chief Electoral Officer
I, _____________________________________________________________________________ , returning officer for the
constituency of _____________________________________________________________ , swear (or solemnly affirm):
1 That of the envelopes received by me as returning officer from the Chief Electoral Officer with respect tothe recent election for the constituency, I have not opened or permitted to be opened any of the envelopesexcept those authorized and directed to be opened by a returning officer pursuant to The Election Act, 1996;
2 That none of the other envelopes have been opened by any person since they were returned to me by theChief Electoral Officer (or in case of a recount add, except by the judge on a recount);
3 That I have not ascertained and have not attempted to ascertain from the ballot papers or other contents ofany of the envelopes how any person voted;
4 That I have this day sent to the Chief Electoral Officer my return with respect to the election.
So help me God.(if sworn)
Sworn (or solemnly affirmed) before me at the _____________ _______________________________of _______________________ in the Province of Saskatchewan Signature of Returning Officerthis ___________ day of________________________ , ________ .
_________________________________________________________A Commissioner, etc. (or as the case may be)
}
2 Jan 98 cE-6.01 Reg 2.
13ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
FORM L[Section 155 of the Act]
Notice of Request for Recount or Addition
To: __________________________________________________________________________________________________(insert full name)
Returning Officer for the constituency of ______________________________________________________________
Pursuant to The Election Act, 1996:
1 I _______________________________________________ , of _____________________________ , Saskatchewan,a candidate for the constituency of _______________________________________________________________at the election held on the ______________________ day of _________________________ , _____________ .
(or)
I ____________________________________________________ , of _______________________ , Saskatchewan,a duly appointed business manager of ____________________________________________________________ ,a candidate for the constituency of _______________________________________________________________at the election held on the _________________ day of _______________________________ , ____________ :
(a) request a recount or addition of the votes cast at the election; and(b) request that you issue a certificate as required by section 155 of The Election Act, 1996.
2 My address for service of all documents required to be served on me is ______________________________________________________________________________________________________________________________
(Note – The address for service must be a specific address; if the candidate has retained a solicitor to act for himor her, the name of the solicitor and his or her business address shall be set out in full.)
Dated at _____________________ , Saskatchewan, this ___________ day of __________________ ,_________ .
____________________________________________________Signature of Candidate or Business Manager
2 Jan 98 cE-6.01 Reg 2.
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17 Feb 2006 SR 6/2006 s4.
FORM M [Section 155 of the Act]
Certificate of Returning Officer (Recount or Addition)
Constituency of
Pursuant to the written request of
of , Saskatchewan, a candidate for the constituency
of , (or of
of , Saskatchewan, Business Manager of
a candidate for the constituency of ) at the election held on the
day of , 20____; and pursuant to section 155 of The Election Act, 1996,
I, the undersigned Returning Officer for the constituency of
certify as follows:
1. That the majority of the votes cast at the election according to my addition, in favour of
, the candidate declared by me to have been
elected, is ;
That the number of all unopened ballot envelopes is ;
That the number of all ballots rejected is ; and
That the number of all ballots objected to is .
[or in the case of a tied result]
2. That on the final count I have found two or more candidates having the same number of votes and
that casting a vote would entitle one of the candidates to be declared elected, therefore I have
declared the result to be a tie vote.
Dated at , Saskatchewan, this day of , 20 .
reciffO gninruteR fo erutangiS
15ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
FORM N[Section 20 of the Act]
Appointment of Enumerator by Returning Officer
Constituency of _______________________________________________________________________________________
In my capacity of returning officer, I appoint ____________________________________________________________of _____________________________________________________________ , to act as enumerator for Polling DivisionNo. (or in the case of a personal care facility insert name of facility) for the election now pending.
Dated this_______________ day of ______________________ , ____________ .
_____________________________________________________Signature of Returning Officer
2 Jan 1998 cE-6.01 Reg 2.
FORM O[Section 20 of the Act]
Oath or Declaration of Enumerator
I, the undersigned,____________________________________ , appointed enumerator for Polling Division No. (or
in the case of a personal care facility insert name of facility) of the constituency of __________________________in the Province of Saskatchewan, do swear (or solemnly affirm) that I will act faithfully in the capacity ofenumerator without partiality, fear, favour or affection.
(So help me God.)(if sworn)
Sworn (or solemnly affirmed) before me at the _____________ _______________________________of _______________________ in the Province of Saskatchewan Signature of Enumeratorthis ___________ day of________________________ , ________ .
_________________________________________________________A Commissioner, etc. (or as the case may be)
}
2 Jan 1998 cE-6.01 Reg 2.
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FORM P[Section 10 of the Act]
Appointment of Deputy Returning Officer
To ___________________________________________________________________________________________________(insert full name, residential address and occupation)
In my capacity of returning officer for the constituency of ________________________________________________ ,
I appoint you to be deputy returning officer for Polling Division No. (or in the case of a hospital, personal carefacility or remand centre insert name of facility) (or in the case of advance, temporarily displaced voter or mobilepolling insert type of poll) in the constituency, there to take the votes of the voters. You are authorized andrequired to open the polling place and conduct the taking of the votes of the voters at the polling place on the______________________ day(s) of ________________________ , at 9:00 a.m. (or as the case may be) at (heredescribe particularly the place in which the voting is to be held) and there to keep the polling place open duringthe hours prescribed by law, and to do and perform in that polling place all acts and duties required to beperformed by the deputy returning officer appointed to act, and, after counting the votes given, to return to methe ballot box sealed with your seal (or in the case of hospital, remand centre or temporarily displaced voterpolling forward to the Chief Electoral Officer the ballot box containing the ballot envelopes) and enclosing theballots, envelopes, voters’ list(s) and other documents required by law, together with this appointment.
Given under my hand this ______________ day of _______________________ , ____________ .
____________________________________________________Signature of Returning Officer
2 Jan 1998 cE-6.01 Reg 2.
FORM Q[Section 10 of the Act]
Oath or Declaration of Deputy Returning Officer
I, _________________________________________________________________________________________ , appointeddeputy returning officer for the Polling Division No. (or in the case of a hospital, personal care facility or remandcentre insert name of facility) (or in the case of advance, temporarily displaced voter or mobile polling insert typeof poll) of the constituency of____________________________ , swear (or solemnly affirm) that I am legallyqualified to act as deputy returning officer, and that I will act faithfully in that capacity without partiality, fear,favour or affection.
(So help me God.)(if sworn)
Sworn (or solemnly affirmed) before me at the _____________ ____________________________________of _______________________ in the Province of Saskatchewan Signature of Deputy Returning Officerthis ___________ day of________________________ , ________ .
_________________________________________________________A Commissioner, etc. (or as the case may be)
}
2 Jan 1998 cE-6.01 Reg 2.
17ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
FORM R[Section 37 of the Act]
Appointment of Supervisory Deputy Returning Officer
To:___________________________________________________________________________________________________ ,(insert full name, residential address and occupation)
In my capacity of returning officer for the constituency of ________________________________________________ ,
I appoint you to be supervisory deputy returning officer for the central polling place at (here describe particularlythe place in which the voting is to be held) in the constituency, there to attend throughout polling day,the ________________________ day of ____________________________ , _____________ , for the purpose of keepingme fully informed with respect to matters affecting or likely to affect peace and good order in the central pollingplace.
Given under my hand this _____________ day of _____________________ , ___________ .
______________________________________________________Signature of Returning Officer
2 Jan 1998 cE-6.01 Reg 2.
FORM S[Section 37 of the Act]
Oath or Declaration of Supervisory Deputy Returning Officer
I, __________________________________________________ , appointed supervisory deputy returning officer for thecentral polling place at (here describe particularly the place in which the voting is to be held) in the constituencyof _____________________________________________ , swear (or solemnly affirm) that I am legally qualified to actas supervisory deputy returning officer, and that I will act faithfully in that capacity without partiality, fear,favour or affection.
(So help me God.)(if sworn)
Sworn (or solemnly affirmed) before me at the _____________ _____________________________________of _______________________ in the Province of Saskatchewan Signature of Supervisory Deputy Returning Officer
this ___________ day of________________________ , ________ .
_________________________________________________________A Commissioner, etc. (or as the case may be)
}
2 Jan 1998 cE-6.01 Reg 2.
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FORM T[Section 13 of the Act]
Appointment of Poll Clerk
To:__________________________________________________________________________________________________(insert full name, residential address and occupation)
In my capacity of deputy returning officer for Polling Division No. (or in the case of a hospital, personal carefacility or remand centre insert name of facility) (or in the case of advance, temporarily displaced voter ormobile polling insert type of poll) in the constituency of ________________________________________________ ,I appoint you to be poll clerk for that polling place.
Given under my hand this ______________ day of __________________ , ________.
____________________________________________________Signature of Deputy Returning Officer
2 Jan 1998 cE-6.01 Reg 2.
FORM U[Section 13 of the Act]
Oath or Declaration of Poll Clerk
I, ________________________________________________________________________________ , appointed poll clerkfor Polling Division No. (or in the case of a hospital, personal care facility or remand centre insert name offacility) (or in the case of advance, temporarily displaced voter or mobile polling insert type of poll) in theconstituency of __________________________________________________________________ , swear (or solemnlyaffirm) that I am legally qualified to act as poll clerk and that I will act faithfully in that capacity and also in thecapacity of deputy returning officer, if so required, according to law, without partiality, fear, favour or affection.
(So help me God.)(if sworn)
Sworn (or solemnly affirmed) before me at the _____________ _______________________________of _______________________ in the Province of Saskatchewan Signature of Poll Clerkthis ___________ day of _______________________ , ________ .
_________________________________________________________A Commissioner, etc. (or as the case may be)
}
2 Jan 1998 cE-6.01 Reg 2.
19ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
FORM V[Section 78 of the Act]
Oath or Declaration of Interpreter
I, _______________________________________ swear (or solemnly affirm) that I will faithfully translate any oath,(insert full name)
declaration or lawful questions that the deputy returning officer shall require me to put to the voter and that I willfaithfully translate the voter’s answers.
(So help me God.)(if sworn)
Sworn (or solemnly affirmed) before me at the ______________ _______________________________of _______________________ in the Province of Saskatchewan Signature of Interpreterthis ___________ day of________________________ , ________ .
_________________________________________________________A Commissioner, etc. (or as the case may be)
}
2 Jan 1998 cE-6.01 Reg 2.
FORM W[Section 14 of the Act]
Oath or Declaration of Secrecy
Constituency of _______________________________________________________________________________________
Polling Division No. (or in the case of a hospital, personal care facility or remand centre insert name of facility)(or in the case of advance, temporarily displaced voter or mobile polling insert type of poll).
I, ________________________________________________________________________ , swear (or solemnly affirm):(insert full name, residential address and occupation)
1 That I will not attempt to ascertain and will by every means in my power prevent any other person fromascertaining how any person is about to vote or has voted at this election, except as may be necessary andproper in the case of persons blind or unable to read or incapable of marking their ballot papers as providedin The Election Act, 1996;
2 That I will not communicate to any person any information of any kind that may enable or assist anyperson to ascertain the candidate for whom any person has voted; and
3 That I will in all respects maintain and aid in maintaining the absolute secrecy of the voting at this pollingplace.
(So help me God.)(if sworn)
Sworn (or solemnly affirmed) before me at the _____________ _______________________________of _______________________ in the Province of Saskatchewan Signature of Personthis ___________ day of _______________________ , ________ .
_________________________________________________________A Commissioner, etc. (or as the case may be)
}
2 Jan 1998 cE-6.01 Reg 2.
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
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E-6.01 REG 2
31 Oct 2014 SR 85/2014 s5.
FORM Y[Sections 77 and 78 of the Act]
Oath or Declaration of Friend of Voter
You swear (or solemnly affirm):
That you know (full name of voter who has a disability that significantly restricts the voter’s ability to voteor voter who is unable to understand the English language) who has applied to vote at this polling place, andyou have heard the voter take the oath or make the declaration in Form X of The Election Act, 1996 andbelieve the matters sworn to are true in substance and in fact;
That you have been requested by (full name of voter who has a disability that significantly restricts thevoter’s ability to vote or voter who is unable to understand the English language) to mark the ballot paper,and you will keep secret the name of the candidate being marked for the voter on the ballot paper; and
That you have not acted and will not act for any more than two voters who have a disability that significantlyrestricts the voter’s ability to vote or voters who are unable to understand the English language, at thiselection (to be included only with respect to the Oath or Declaration of a friend who marked the ballot paperfor a voter who has a disability that significantly restricts the voter’s ability to vote or voter who is unable tounderstand the English language).
(So help me God.)(if sworn)
31 Oct 2014 SR 85/2014 s5.
FORM X[Sections 77 and 78 of the Act]
Oath or Declaration of Inability to Mark Ballot Paper
You swear (or solemnly affirm) that you have a disability that significantly restricts your ability to vote, orthat you do not understand the English language (as the case may be).
(So help me God.)(if sworn)
21ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
}
FORM Z[Sections 93, 100, 108, 116, 124, 135 and 141 of the Act]
Oath or Declaration of Poll Clerk after Closing ofthe Polling Place for Voting
I, ___________________________________________ , poll clerk for Polling Division No. (or in the case of a hospital,personal care facility or remand centre insert name of facility) (or in the case of advance, temporarily displacedvoter or mobile polling insert type of poll) in the constituency of __________________________________________ ,swear (or solemnly affirm) that the poll book for the polling place kept under the direction of______________________________________________________________________________________________________ ,
(insert full name)who acted as deputy returning officer, has been kept by me correctly to the best of my skill and judgment; thatthe total number of votes cast according to the poll book is __________ ; and that to the best of my knowledgeand belief it contains a true and exact record of the voters who voted at the polling place.
Sworn (or solemnly affirmed) before me at the _____________ _______________________________of _______________________ in the Province of Saskatchewan Signature of Poll Clerkthis ___________ day of _______________________ , ________ .
_________________________________________________________A Commissioner, etc. (or as the case may be)
2 Jan 1998 cE-6.01 Reg 2.
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
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2 Jan 1998 cE-6.01 Reg 2.
FORM AA[Sections 93, 100, 108, 116, 126, 135 and 143 of the Act]
Oath or Declaration of Deputy Returning Officer after Closingof the Polling Place for Voting
I, ______________________________________, deputy returning officer for Polling Division No. (or in the case of ahospital, personal care facility or remand centre insert name of facility) (or in the case of advance, temporarilydisplaced voter or mobile polling insert type of poll) in the constituency of ________________________________ ,swear (or solemnly affirm) that, to the best of my knowledge and belief:
1 The poll book kept for the polling place under my direction has been kept correctly;
2 The total number of votes cast according to the poll book is _______________________ ;
3 The poll book contains a true and exact record of the votes cast at the polling place;
4 I have correctly counted the votes cast for each candidate (not to be included in the oath of a deputyreturning officer conducting the taking of the votes of the voters in a hospital, remand centre or temporarilydisplaced voter poll);
5 I have performed all duties required of me by law;
6 The voters’ list, poll book, and other documents, etc., required by law to be returned by me to the returningofficer have been faithfully and truly prepared and placed in the ballot box and are contained in the ballotbox returned by me to the returning officer, which was locked and sealed by me in accordance with TheElection Act, 1996 and remained so locked and sealed while in my possession;
7 I have forwarded to the Chief Electoral Officer, Regina, the ballot box containing the ballot envelopes (to beincluded only with respect to the oath of a deputy returning officer who conducted a hospital, remandcentre or temporarily displaced voter poll at a general election).
Sworn (or solemnly affirmed) before me at the _____________ ____________________________________of _______________________ in the Province of Saskatchewan Signature of Deputy Returning Officerthis ___________ day of________________________ , ________ .
_________________________________________________________A Commissioner, etc. (or as the case may be)
}
23ELECTION FORMS
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FORM BB[Sections 93, 100, 108, 116, 126, 135 and 143 of the Act]
Receipt for Ballot Box
(To be Retained by Deputy Returning Officer)
Constituency of ________________________________________________________________________________________
Polling Division No. (or in the case of a hospital, personal care facility or remand centre insert name of facility)(or in the case of advance, temporarily displaced voter or mobile polling insert type of poll).
I received from _________________________________________________________ , deputy returning officer for theabove-described polling division, the ballot box used in the recent election for the voting held in the pollingdivision, the ballot box being locked and sealed as provided by The Election Act, 1996, and delivered the ballotbox, in the same condition as I received it, to _____________________________________________________________of ________________________________________________ , the returning officer for the above-named constituency.
Dated at ______________________________ , Saskatchewan, this _______ day of _________________ , ______ .
________________________________________ _______________________________________________Signature of Deputy Returning Officer Signature of Messenger
2 Jan 1998 cE-6.01 Reg 2.
FORM CC[Sections 93, 100, 108, 116, 126, 135 and 143 of the Act]
Oath or Declaration of Messenger who Delivers the BallotBox to the Returning Officer
I, ___________________________________________________ , swear (or solemnly affirm) that I am the person towhom __________________________________________________ , deputy returning officer for Polling Division No.(or in the case of a hospital, personal care facility or remand centre insert name of facility) (or in the case ofadvance, temporarily displaced voter or mobile polling insert type of poll) of the ____________________________
(City, Town or Village)of _____________________________ in the constituency of ____________________________________ , entrusted theballot box for the polling place to be delivered to ___________________, the returning officer;
1 That the ballot box which I delivered to the returning officer this day is the ballot box I so received; and2 That I have not opened it and that it has not been opened by any other person since I received it from the
deputy returning officer.
(So help me God.)(if sworn)
Sworn (or solemnly affirmed) before me at the _____________ _______________________________of _______________________ in the Province of Saskatchewan Signature of Messengerthis ___________ day of _______________________ , ________ .
_________________________________________________________Signature of Returning Officer
}
2 Jan 1998 cE-6.01 Reg 2.
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
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FORM DD[Sections 71, 81, 82, 99, 107, 115 and 123 of the Act]
Declaration of Voter
Part 1: Voter Making a Declaration (Declaring Voter)Voter’s Polling
Date of Writ , Voter’s Constituency Division Number
Last Name of Voter First Name of Voter Middle Name or Initial of Voter
G Male G Female Date of Birth (yyyy/mm/dd) Occupation (e.g., labourer)
Number & Street (e.g., 123 Main Street) Apartment/Unit (e.g., Apt. 4 or Unit 4) or Land Location (e.g., NE20-16-10 W3M)
, SaskatchewanCity, Town or Village (e.g., Ile-a-la-Crosse) Postal Code (e.g., S4N 6B2)
Mailing Address (if different than ordinary residential address given above)
Number & Street or Post Office Box Apartment/Unit
, SaskatchewanCity, Town or Village (e.g., Ile-a-la-Crosse) Postal Code (e.g., S4N 6B2)
Part 2: Declaration of Voter (to be completed by voter applying for a ballot)
! I am the full age of 18 years or will attain the full age of 18 years on or before Polling Day;! I am a Canadian citizen or a British subject and was qualified as a voter (in Saskatchewan) on June 23, 1971;! I have ordinarily resided in Saskatchewan for at least six months immediately preceding the day the writ was
issued;! I was ordinarily resident in the above-mentioned constituency on the day the writ was issued; ! I am not disqualified pursuant to section 17 of The Election Act, 1996 to vote at this election; ! I have not already voted at this election; and
I make this solemn declaration conscientiously, believing it to be true and knowing that it is of the same force and effectas if made under oath and by virtue of the Canada Evidence Act.
Date Signature of Applicant/Voter
G I do not want my name added to the Register of Voters
25ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
31 Oct 2014 SR 85/2014 s5.
Part 3: Voter Vouching (for an individual who is not on the voters’ list and does not have acceptable identification)
I, , being a qualified voter in the above-named constituency, appearing on the voter’s list, (Printed Name of Voter Vouching)
having provided satisfactory evidence of the voter’s identity and ordinary residence at (Address of Voter Vounching)
to the poll clerk, confirm that the declaring voter is known to me and that the information provided by the declaringvoter as to identity and place or ordinary residence is accurate and that I have only vouched for one voter at thiselection.
Signature of Voter Vouching for Declaring Voter
Part 4: For Use by Election Officer
Acceptable identification presented by voter who is vouching
Voter who is vouching is on the Voters’ List
Yes
Yes
No
No
Signature of Election Officer
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
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E-6.01 REG 2
Ballot Paper Account and Poll Statement(To be made by deputy returning officer, at close of the taking of the votes of the voters,
in accordance with sections 93, 100, 108, 116, 124, 135 and 141)
Constituency of ________________________________ Polling Division No. ______________________________(or in the case of a hospital, personal carefacility or remand centre insert name offacility) (or in the case of advance, displacedvoter or mobile polling insert type of poll )
1 Total number of names on the voters’ list
Ballot Paper Account
2 Number of ballot papers (Form A) received from returning o
(or)
Number of ballot papers (Form B) received from returning o
3 Number appearing in poll book as having voted
4 Number of unused ballot papers (Form A)
(or)
Number of unused ballot papers (Form B)
5 Number of ballot papers (Form A) spoiled or declined
(or)
Number of ballot papers (Form B) spoiled or declined
6 Number of ballot papers unaccounted for (if any)
Total
NOTE: These totals must agree.
(To be completed with respect to all polling places except hospital, remand centre or temporarily displaced voter polls.)
7 Number of voters appearing in poll book as having voted:
(a) without making a declaration
(b) after making a declaration
Form EE[Sections, 93, 100, 108, 116, 124, 135 and 141 of the Act]
27ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
(To be completed only with respect to polling places in a hospital, remand centre or temporarily displaced voter poll.)
8 Number of voters appearing in poll book as having voted, who:
(a) reside in the constituency
(b) do not reside in the constituency
Total
NOTE: The total under 7 or 8 must agree with 3.
(To be completed with respect to all polling places except polling places in a hospital, remand centre or temporarilydisplaced voter poll.)
9 Number of ballots cast for ( insert name of candidate )
Number of ballots cast for ( insert name of candidate )
Number of ballots cast for ( insert name of candidate )
Number of ballots cast for ( insert name of candidate )
Number of ballots cast for ( insert name of candidate )
Number of ballots cast for ( insert name of candidate )
10 Number of rejected ballots
Total
NOTE: This total must agree with 7.
I certify that the above statement is correct.
Dated at _________________ , this___________ day of _______________________ , _________ .
_________________________________________ ____________________________________________Poll Clerk Deputy Returning O r
(Candidates or representatives may also sign.)
13 Jly 2001 SR 47/2001 s3.
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
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E-6.01 REG 2
31 Oct 2014 SR 85/2014 s5.
FORM FF[Section 77 of the Act]
Ballot Template
This template, valid for a ballot paper (Form A) with a maximum of eight candidates, is for the use of a voterwho has a disability that significantly restricts the voter’s ability to vote and who does not wish to be assistedby a friend or the deputy returning officer in marking the ballot.
The portion of the template containing the circular holes shall be coloured black with instructions reading asfollows:
General Instruction to Deputy Returning Officer
! Voters who have a disability that significantly restricts their ability to voteARE NOT required to take the oath of an incapacitated voter when usingthis template
! Your poll clerk will make the usual entry in the poll book, i.e. “voted”
Procedure in the handling of the Ballot Paper
! Detach voter’s ballot paper from the book and fold it in the prescribed way
! Unfold ballot paper and place it inside template in such a way that the firstcircle on the ballot is aligned with the first circle on the template
! IF ASKED, inform voter of the order in which the names of the candidatesappear on the ballot paper
! Direct the voter to refold his/her ballot paper, after marking it, using as aguide the ridges left when you folded it
29ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
FORM GG[Section 140 of the Act]
Notice to Voters - Northern Constituencies
Public notice is given that registration will be made of all persons qualified to vote, in the election now pending, at the
polling places named in my proclamation dated the day of , .
The enumerator appointed by me for the territory adjacent to the polling place located at
is of in this constituency.
Application for registration may be made to the enumerator by any person ordinarily resident in the territory adjacent
to that polling place at any time from a.m./p.m. to p.m. from
to .
The enumerator will sit for revision of the voters’ list at
between the hours of and from to .
Given under my hand at this day of , .
Returning Officer
31 Oct 2014 SR 85/2014 s5.
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
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E-6.01 REG 2
FORM HH[Sections 58 and 191 of the Act]
Directions for the Guidance of Voters
A voter may vote for one candidate only.
Voter’s Declaration – A patient in a hospital, a remand prisonerin a remand centre, or a temporarily displaced voter may voteonly if he or she makes a voter’s declaration at the pollingplace.
Persons whose names appear on the voters’ list may be requiredto make the declaration and if so required will be allowed tovote only after making the voter’s declaration.
HOW TO VOTE
Step 1: On receiving a ballot paper, the voter shall proceed to avoting station provided for the purpose of voting.
Step 2: The voter shall mark the ballot paper by placing a crossor other mark that clearly indicates the voter’s choice in thecircle to the right of the name of the candidate for whom thevoter intends to vote. An example is below.
DO NOT MARK ANY OTHER PART OF THE BALLOT
In the following example, the Candidates are Bill Brown, JaneHamon, Joseph O’Neil and Alice Smith.
The voter has marked his or her ballot paper in favour of AliceSmith.
Bill BROWN(Political Affiliation)
Farmer
Jane HAMON(Political Affiliation)
Lawyer
Joseph O’NEIL(Political Affiliation)
Printer
Alice SMITH(Political Affiliation)
Teacher
Step 3: After marking the ballot paper, the voter will fold theballot paper so that the names of the candidates and the voter’smark on the ballot are concealed, but the initials of the DeputyReturning Officer are exposed.
Leave the voting station with your ballot.
Step 4: (a) After leaving the voting station, the voter will immediatelydeliver the folded ballot paper to the Deputy Returning Officer,without showing the front to anyone or displaying the ballotpaper so as to make the name of the candidate for whom he orshe has voted known to any person.(b) The Deputy Returning Officer will examine the initials onthe ballot paper to confirm it is the ballot paper given to thevoter by the Deputy Returning Officer.(c) After removing the counterfoil, the Deputy ReturningOfficer will give the ballot back to the voter.
Step 5: The voter will deposit the ballot in the ballot box orallow the Deputy Returning Officer to deposit the ballot in theballot box.
Step 6: The voter will leave the polling place immediately afterthe ballot has been deposited in the ballot box.
If a voter inadvertently spoils a ballot paper so that he or shecannot conveniently use it as he or she desires, he or she mayreturn it to the Deputy Returning Officer who will give him orher another.
If a voter votes for more than one Candidate, or places anymark on the ballot paper by which he or she can beidentified, his or her vote will be void and WILL NOT becounted.
If a voter fraudulently takes a ballot paper out of the pollingplace or fraudulently delivers to the Deputy Returning Officerto be placed in the ballot box any other paper than the ballotpaper given to him or her by the Deputy Returning Officer, heor she will be disqualified from voting for the next five yearsand is liable to imprisonment for not more than one year.
Warning189(1) No person shall unlawfully take down, cover up, mutilate, deface or alter an election proclamation, notice or other document required to be posted pursuant to thisAct. Any person violating the provision of subsection 189(1) is guilty of an offence and, subject to subsection 216(2) of this Act, if convicted, is liable to a fine of notmore than $5,000.00 or to imprisonment for a term not exceeding two years or to both.
31 Oct 2014 SR 85/2014 s5.
31ELECTION FORMS
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FORM II[Sections 58, 191 and 216 of the Act]
Notice as to Secrecy of Voting
It is the sworn duty of every person in attendance at this polling place or at the counting of the votes not toattempt to ascertain how any person is about to vote or has voted and not to communicate any informationobtained at the polling place that may enable or assist any person to ascertain how any person has voted.
It is further the sworn duty of every such person by all proper means to maintain and aid in maintaining theabsolute secrecy of the voting at this polling place.
A person who acts in contravention of his or her duty in any of these particulars is liable to a fine not exceeding$5,000 or to imprisonment for not more than two years, or to both.
The Election Act, 1996 further provides that every person who fraudulently and without authority destroys, takes,opens or otherwise interferes with a ballot box or book or packet of ballot papers or ballot paper or ballot in use orused for the purpose of an election, or who attempts to do so, is disqualified from voting at any election for the nextfive years and is liable to imprisonment for not more than one year. Also pursuant to the Act, a returning officer,election clerk, supervisory deputy returning officer, deputy returning officer, poll clerk or other officer engaged inthe election who is guilty of a contravention of that provision is liable to imprisonment, without the alternative ofa fine, for not more than two years.
____________________________________________________Chief Electoral Officer
2 Jan 1998 cE-6.01 Reg 2.
FORM JJ[Sections 85 and 125 of the Act]
Statement by Deputy Returning Officer Respecting Voterswho Made the Declaration on Election Day
I, the undersigned, deputy returning officer for Polling Division No. (or in the case of a personal care facility, or ahospital or remand centre in a by-election insert name of facility) in the constituency of ______________________ ,certify that at the election held this _____________ day of _______________________ , ___________ , the personsnamed in the following list made the voter’s declaration on that date for the reasons set forth opposite theirrespective names:
Name of Voter Address Occupation Constituency Reasons forRequiring theDeclaration
Dated at _________________ , Saskatchewan, this _______ day of _________________________ , _________ .
____________________________________________ __________________________________________________reciffO gninruteR ytupeD fo erutangiSkrelC lloP fo erutangiS
(Candidates or representatives may also sign)
2 Jan 1998 cE-6.01 Reg 2.
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
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FORM KK[Sections 93 and 135 of the Act]
Voters who voted at(in the case of advance polling insert Advance Poll)
(or in the case of mobile polling insert Mobile Poll (Held On Any Advance Polling Day)or Mobile Poll (Held On Polling Day))
List of voters voting at Advance Poll in the Constituency of ________________________________________________on (here state the days, dates, month and year established for advance polling in the constituency)
(or)
List of voters voting at Mobile Poll in the Constituency of __________________________________________________at (here state the location(s)) on (day(s), date(s), month and year established for mobile polling in the constituency)
To be made by Deputy Returning Officer and furnished to Returning Officer at the close of poll held on anyadvance polling day in accordance with section 135 of The Election Act, 1996.
(or)
To be made by Deputy Returning Officer and furnished to Returning Officer at the close of any mobile poll held onany advance polling day in accordance with section 93 of The Election Act, 1996.
(or)
To be made by Deputy Returning Officer and furnished to Returning Officer at the close of mobile poll held onpolling day in accordance with section 93 of The Election Act, 1996.
Name of Voter Location of Residence Post Office Polling DivisionOf Voter Address Occupation Number Remarks
(For advance polling or mobile polling held on any advance polling days include the following statement)
Note: Those voters whose names appear on the above list shall be removed from the Revised Voters’ List priorto opening of polling places on polling day.
_________________________________________________Signature of Deputy Returning Officer
2 Jan 1998 cE-6.01 Reg 2.
FORM LL[Sections 21, 22, 24 and 28 of the Act]
Voters’ List
Constituency of _________________________ Polling Division No. ___________________________________________(or in the case of a personal care facilityinsert name of facility)
Election Date ______________________________
eciffO tsoPro )laruR( noitacoL dnaL PostalNumber Street and Number (Cities and Towns) Name Occupation Address Code
2 Jan 1998 cE-6.01 Reg 2.
33ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
31 Oct 2014 SR 85/2014 s5.
FORM MM[Section 25(6) of the Act]
Certificate of Returning Officer
I certify that the foregoing is a true copy of the voters’ list in Polling Division No. (or in the case of a
personal care facility insert name of facility) of the constituency of
as prepared by me for use in the election now pending of a member of the Legislative Assembly of
Saskatchewan for that constituency.
Dated this day of , .
Signature of Returning Officer
Name of Returning Officer Phone Number and Address of Returning Officer
Revision will take place at
FORM NN[Section 28 of the Act]
Certificate of Revision
(Here the Returning Officer shall make any addition to the list that he or she finds necessary.)
I certify that the foregoing is a corrected list of the voters in Polling Division No. (or in the case of a
personal care facility insert name of facility) of the constituency of
as revised (or if no correction is made as finally approved) by me this day of
.
Signature of Returning Officer
31 Oct 2014 SR 85/2014 s5.
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
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E-6.01 REG 2
17 Feb 2006 SR 6/2006 s4.
FORM OO [Section 87 of the Act]
Absentee Voter Declaration
Declaration of Voter
• I am the full age of 18 years or will attain the full age of 18 years on or before Polling Day; • I am a Canadian citizen or a British subject who was qualified as a voter on June 23, 1971; • I have ordinarily resided in Saskatchewan for at least six months immediately preceding the day the
writ was issued; • I was ordinarily resident in the above-mentioned constituency on the day the writ was issued; • I am not disqualified pursuant to section 17 of The Election Act, 1996 to vote at this election; • I am unable to vote at an advance poll or on Polling Day in the constituency in which I am an
ordinary resident; and • I have not already voted at this election.
I understand that upon issuance of an Absentee Ballot Kit under the absentee voters provisions, I will be deemed to have voted.
I make this solemn declaration conscientiously, believing it to be true and knowing that it is of the same force and effect as if made under oath and by virtue of the Canada Evidence Act.
Signature of Applicant/Voter Date
35ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
17 Feb 2006 SR 6/2006 s4.
FORM PP [Section 88 of the Act]
Certificate Envelope
To be completed by the Returning Officer:
Constituency of
of Name of Voter
Address (Street and Number) and (apt. or unit) or Land Location
, Saskatchewan City, Town or Village Postal Code
To be completed by the absentee voter:
Insert ballot envelope (E-130A) in this envelope, seal and complete the following certificate.
I certify that I am entitled to vote pursuant to sections 87 to 89 of The Election Act, 1996, because I am unable to vote at an advance poll or on Polling Day in the constituency in which I am an ordinary resident and that enclosed in this envelope is a ballot envelope that contains the ballot received by me and marked by me.
Dated this day of , 20 .
Signature of Voter
FORM QQ[Section 88 of the Act]
Outer Envelope to the Returning Officer
Returning Officer
Constituency of ________________________________________________________________________________________
_______________________________________________________________________________________________________(Address of Returning Officer)
2 Jan 1998 cE-6.01 Reg 2.
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
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E-6.01 REG 2
17 Feb 2006 SR 6/2006 s4.
FORM RR [Section 89 of the Act]
Statement of Absentee Ballots Mailed or Delivered to the Returning Officer
Constituency of
NUMBER OF BALLOTS
Number of certificate envelopes deposited in ballot box
Number of unopened certificate envelopes rejected
Number of unopened outer envelopes received after the deadline
Number of ballot papers not returned (if any)
Number of ballot papers spoiled or declined
Number of unused ballot papers
B stollab eetnesba latoT
NUMBER OF BALLOT PAPERS
Total number of ballot papers assigned to the absentee voting process C
The seal locking this ballot box bears number . I certify that the above statement is correct.
Dated at , Saskatchewan, this day of , 20 .
reciffO gninruteR fo erutangiS
BALLOTS COUNTED FOR EACH CANDIDATE
Number of ballots cast for:
Number of ballots cast for:
Number of ballots cast for:
Number of ballots cast for:
Number of ballots cast for:
Number of ballots cast for:
Number of rejected ballots
A xob tollab ni stollab eetnesba latoT
37ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
FORM SS[Sections 31, 44 and 238 of the Act]
Nomination Paper
Part I
We, the undersigned voters of the constituency of ________________________________________________________ ,nominate (name, political affiliation, if any, and occupation) of (address) as a candidate at the election about to beheld of a member to represent that constituency in the Legislative Assembly of Saskatchewan.
If the person is absent from Saskatchewan it must be stated here.
Signature of Voter Address of Voter Occupation of Voter Signature of Witness
(Several signatures of voters may be bracketed and a witness need only sign once opposite the bracket for the wholeseries of signatures that he or she witnessed).
Part IICONSENT OF CANDIDATE
I, ________________________________ , nominated in the foregoing nomination paper hereby consent to such(name of candidate)
nomination.
I declare that the name and address of my business manager is ____________________________________________of _______________________________________ in the Province Saskatchewan and that the name and address of
(state residential address)
my auditor is _______________________________ of _______________________________________________________in the Province of Saskatchewan.
I request that my name be set forth on the ballot paper in the following form:
I request that my political affiliation be set forth on the ballot paper in the following form:
I designate the following as my address for service of all notices, documents or other papers required to be servedupon me pursuant to either The Election Act, 1996 or The Controverted Elections Act, namely:
Signed by the above named(name of candidate)in the presence of ___________________________ _____________________________________________
Signature of Candidate
___________________________________________Witness
}
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
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E-6.01 REG 2
Part IIICONSENT OF BUSINESS MANAGER
I, ________________________________________________ of _________________________________________________ ,being a qualified voter in the Province of Saskatchewan, hereby consent to my appointment to act as businessmanager for __________________________________________________________ , the candidate nominated at theelection about to be held of a member to represent the constituency of ______________________________________in the Legislative Assembly of Saskatchewan.
Dated at ________________ , in the Province of Saskatchewan, this ________ day of _____________ ,__________ .
_____________________________________________Signature of Business Manager
Part IVAFFIDAVIT OF ATTESTATION TO BE TAKEN BY WITNESS
TO SIGNATURES OF NOMINATORS
I, _________________________________________ of _________________________________________________________in the Province of Saskatchewan, make oath and say (or solemnly affirm) that I know the nominators whosesignatures to the foregoing nomination paper I have witnessed and that they are duly qualified voters in theconstituency of __________________________________ at the election about to be held and that each of them signedthe foregoing nomination paper in my presence.
Sworn (or solemnly affirmed) before me at the ______________ _______________________________of _______________________ in the Province of Saskatchewan Signature of Person Attestingthis ___________ day of________________________ , ________ .
_________________________________________________________A Commissioner, etc. (or as the case may be)
}
Part VAFFIDAVIT OF ATTESTATION TO BE TAKEN BY WITNESS
TO SIGNATURE OF CANDIDATE
I, __________________________________________ of ________________________________________________________in Province of Saskatchewan, make oath and say (or solemnly affirm) that I know __________________________ ,nominated as a candidate in the foregoing nomination paper, and that he or she signed his or her consent to thenomination in my presence.
Sworn (or solemnly affirmed) before me at the ______________ _______________________________of _______________________ in the Province of Saskatchewan Signature of Person Attestingthis ___________ day of________________________ , ________ .
_________________________________________________________A Commissioner, etc. (or as the case may be)
}
2 Jan 1998 cE-6.01 Reg 2.
39ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
FORM TT[Sections 46 and 48 of the Act]
Certificate Respecting Nomination Paper and Deposit
Constituency of ________________________________________________________________________________________
I acknowledge receipt of a valid nomination paper filed on behalf of ________________________________________and nominating him or her as a candidate at the election now about to be held of a member to represent the aboveconstituency in the Legislative Assembly of Saskatchewan. I also acknowledge receipt of a deposit of $100 madeon his or her behalf.
Dated at ______________ , Saskatchewan, this _________ day of ____________________ , __________ .
______________________________________________________Signature of Returning Officer
FORM UU[Section 52 of the Act]
Withdrawal of Candidate
Constituency of ________________________________________________________________________________________
I, ____________________________________________ , a candidate nominated for the above constituency, withdraw.
Dated at _________________ , Saskatchewan, this _______ day of ________________ , _______ .
____________________________________________________Signature of Candidate
2 Jan 1998 cE-6.01 Reg 2.
2 Jan 1998 cE-6.01 Reg 2.
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
40
E-6.01 REG 2
FORM VV [Section 261 of the Act]
Candidate’s Return of Election Expenses On Behalf of
Name of Candidate
Return
I, of sserddA emaN
edoC latsoP )sserdda laitnediser eht morf tnereffid fi( sserddA gniliaM
Telephone Number Residence ( ) Business ( )
in the province of Saskatchewan, being the business manager of the above-named candidate at the election of a member to serve in the Legislative Assembly of Saskatchewan held on the day of
, in the constituency of make the following Return respecting the election expenses of the said candidate.
Signature of Business Manager
Date Note
1. This Return must be transmitted to the Returning Officer within three (3) months after Polling Day. Subsection 261(1) of the Act
2. This Return must be accompanied by the auditor’s report to the business manager of the candidate on the information given in this Return.
Subsection 261(1) of the Act
3. The commercial value of goods and services donated (other than volunteer labour or goods valued at $200.00 or less), and the difference between the amount paid and the commercial value of goods and services provided, are considered to be election expenses. If the total of “commercial value” is greater than the total of “amount paid” it is the larger of the two figures that is used in the calculation of election expenses incurred by the candidate. See definition of “commercial value”, Clause 220(c) of the Act.
4. A statement, signed and receipted, by the donor and by the business manager, supported by a verification from an independent commercial source of the amount expensed, must be submitted when making a claim of commercial value as an election expense.
Clauses 220(c) and 261(2)(a) of the Act
5. All payments of more than $25.00 must be accompanied by a supplier document that states the particulars of the election expense and by a receipt or cancelled cheque that provides proof of payment. The supplier documents and proofs of payment must be submitted with this Return.
Section 255 of the Act Subclause 261(2)(i) of the Act
41ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
Designation of Reimbursement
I. Contributions Exceed Election Expenses
Section 269 of the Act
If the value of all contributions received exceeds the election expenses incurred by or on behalf of the candidate, the Minister of Finance shall:
(a) where the candidate was endorsed by a registered political party, pay any reimbursement to the chief official agent of the registered political party or the business manager, as directed by the candidate. (Indicate below to whom reimbursement is to be paid.)
__________________________________________________________________________________ Name of Payee
__________________________________________________________________________________ Address Postal Code
(b) where the candidate was not endorsed by a registered political party, pay no reimbursement.
II. Contributions and Reimbursement Exceed Election Expenses
Section 270 of the Act
If the value of all contributions received does not exceed the election expenses but the value of those contributions and the reimbursement calculated exceeds the election expenses incurred by or on behalf of the candidate, the Minister of Finance shall:
(a) where a candidate was endorsed by a registered political party, pay to the chief official agent of the registered political party or the business manager, as directed by the candidate, those contributions and the reimbursement less the election expenses (Indicate below to whom reimbursement is to be paid:)
__________________________________________________________________________________ Name of Payee
__________________________________________________________________________________ Address Postal Code
and to the business manager an amount equal to the election expenses less the contributions received;
(b) where a candidate was not endorsed by a registered political party, pay to the business manager an amount equal to the election expenses less the contributions received.
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
42
E-6.01 REG 2
Summary of Contributions and Expenses
I. Contributions __________________$ snoitubirtnoC
II. Expenses (a) Candidate’s Campaign Expenses $ __________________
__________________ $ sesnepxE ytteP )b( __________________ $ sesimerP fo eriH )c( __________________ $ gnisitrevdA )d( __________________ $ secivreS )e( __________________ $ deilppuS sdooG )f( __________________ $ elciheV fo eriH dna levarT )g(
(h) Undisputed Claims Unpaid $ __________________ __________________$ SESNEPXE LATOT
__________________ $ smialC detupsiD )i( Candidate Personal Expenses $ __________________
Note: Total Expenses (excluding (h) above) is used for the calculation of the reimbursement.
Part I
Contributions (a) Summary of Contributions
I. Value of Contributions
List below, by class of contributor, the aggregate amounts of (A) contributions in excess of $250.00, (B) contributions of $250.00 or less but more than $25.00, and (C) contributions of $25.00 or less, and the number of contributors of each class who have provided money, goods or services for the use of the candidate by way of a gift, loan, advance, deposit, or other form of assistance (includes goods or services donated or provided at other than their true value).
Class of Contributor Number of Contributors Value of Contributions
slaudividnI .1
snoitaroproC .2
snoinU edarT .3
snoitaicossA ro snoitazinagrO detaroprocninU .4
snosreP fo spuorG ro snosreP rehto ynA .5
Total Contributions
Total Contributions (Excluding Excess Amount)
43ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
II. Contributions Exceed Election Expenses
Section 269 of the Act
If the value of all contributions and any reimbursement received exceeds the election expenses incurred by or on behalf of the candidate, the candidate’s business manager shall:
(a) where a candidate was endorsed by a registered political party, pay the excess amount to the chief official agent of the registered political party or the candidate’s constituency association, as directed by the candidate. If so, indicate to whom such payment has been made and affix to this Return the receipt or cancelled cheque that provides proof of payment.
__________________________________________________________________________________ Name of Payee
__________________________________________________________________________________ Address Postal Code
(b) where a candidate was not endorsed by a registered political party, pay the excess amount to the Minister of Finance. If so, affix to this Return a cheque payable to the Minister of Finance for subsequent deposit, in the general revenue fund, by the Chief Electoral Officer.
III. Death or Withdrawal of Candidate
Section 271 of the Act
If the candidate dies or withdraws from an election and prior to the death or withdrawal the value of all contributions to the candidate exceeds the candidate’s election expenses, the candidate’s business manager shall:
(a) where the candidate was endorsed by a registered political party, pay the excess amount to the chief official agent of the registered political party. If so, indicate to whom such payment has been made and affix to this Return the receipt or cancelled cheque that provides proof of payment.
__________________________________________________________________________________ Name of Payee
__________________________________________________________________________________ Address Postal Code
(b) where the candidate was not endorsed by a registered political party, pay the excess amount to the Minister of Finance. If so, affix to this Return a cheque payable to the Minister of Finance for subsequent deposit, in the general revenue fund, by the Chief Electoral Officer.
Further, if the candidate dies or withdraws before appointing a business manager, the candidate’s estate or the candidate shall pay the excess amount in accordance with the above.
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
44
E-6.01 REG 2
Part I
Contributions
(b) Detail of Contributions
Contributions include money provided to or on behalf of the candidate without compensation from the candidate and includes donations in kind.
Detail of the name of and total amount received from each contributor included in classes 1 to 5 in Part (a) who have provided money, goods or services by way of a gift, loan, advance, deposit or other form of assistance must be reported in the aggregate by classification in the appropriate schedule. Such contributions are to be identified in one of three categories: (A) contributions in excess of $250.00, (B) contributions of $250.00 or less but more than $25.00, and (C) contributions of $25.00 or less. The sum of the categories should reflect the total contributions received for the use of the candidate in each classification schedule.
Where a corporation, trust fund or constituency association makes a contribution, pursuant to subsection 240(6) of The Election Act, 1996, each such contribution must be accompanied by a statement which sets out the name of the person who authorized the contribution on behalf of the corporation, trust fund or constituency association, and the name of and the amount contributed by, each person who made a contribution in excess of $250.00 in a year and whose contribution was used to make up the funds contributed by the corporation, trust fund or constituency association.
Where a registered party makes a contribution, pursuant to subsection 240(7) of The Election Act, 1996,each such contribution must be accompanied by a statement which sets out the name of and the amount contributed by, each person who made a contribution in excess of $250.00 in a year and whose contribution was used to make up the funds contributed by the registered party.
A true and correct copy, certified by the business manager, for each such statement of contribution received pursuant to subsections 240(6) and (7) of the Act, must be affixed to this Return (ss.261(3)).
Revenue received by a candidate from fund-raising activities, meetings and sales of material of a promotional nature are deemed contributions. The total net proceeds from each source indicated must be recorded and, in the aggregate, reported in this Return.
The value of donations in kind must be recorded and included as a contribution received by the business manager where claimed as an election expense. Accordingly, commercial value is an election expense and a contribution concurrently.
45ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
Schedule: 1. Individuals
(A) Contributions in excess of $250.00
Note: List below all contributions where the aggregate value of contributions exceeds $250.00.
tnuomA rotubirtnoC fo emaN
List additional contributors on separate sheet provided and affix to this Return.
List Attached Number of Pages Yes or No
srotubirtnoC fo rebmuN snoitubirtnoC )A( yrogetaC lla fo tnuomA latoT
(B) Contributions of $250.00 or less but more than $25.00
Note: Report the number of contributors and the total value of contributions received, from any individual, of $250.00 or less but more than $25.00.
srotubirtnoC fo rebmuN snoitubirtnoC )B( yrogetaC lla fo tnuomA latoT
(C) Contributions of $25.00 or less
Note: Report the number of contributors and the total value of contributions received, from any individual, of $25.00 or less.
srotubirtnoC fo rebmuN snoitubirtnoC )C( yrogetaC lla fo tnuomA latoT
srotubirtnoC fo rebmuN latoT
snoitubirtnoC latoT
(Sum of Categories (A), (B) and (C))
Enter Totals on Part 1(a) Summary of Contributions Line 1.
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
46
E-6.01 REG 2
Schedule: 2. Corporations
(A) Contributions in excess of $250.00
Note: List below all contributions where the aggregate value of contributions exceeds $250.00.
tnuomA rotubirtnoC fo emaN
List additional contributors on separate sheet provided and affix to this Return.
List Attached Number of Pages Yes or No
srotubirtnoC fo rebmuN snoitubirtnoC )A( yrogetaC lla fo tnuomA latoT
(B) Contributions of $250.00 or less but more than $25.00
Note: Report the number of contributors and the total value of contributions received, from any corporation, of $250.00 or less but more than $25.00.
srotubirtnoC fo rebmuN snoitubirtnoC )B( yrogetaC lla fo tnuomA latoT
(C) Contributions of $25.00 or less
Note: Report the number of contributors and the total value of contributions received, from any corporation, of $25.00 or less.
srotubirtnoC fo rebmuN snoitubirtnoC )C( yrogetaC lla fo tnuomA latoT
srotubirtnoC fo rebmuN latoT
snoitubirtnoC latoT
(Sum of Categories (A), (B) and (C))
Enter Totals on Part 1(a) Summary of Contributions Line 2.
47ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
Schedule: 3. Trade Unions
(A) Contributions in excess of $250.00
Note: List below all contributions where the aggregate value of contributions exceeds $250.00.
tnuomA rotubirtnoC fo emaN
List additional contributors on separate sheet provided and affix to this Return.
List Attached Number of Pages Yes or No
srotubirtnoC fo rebmuN snoitubirtnoC )A( yrogetaC lla fo tnuomA latoT
(B) Contributions of $250.00 or less but more than $25.00
Note: Report the number of contributors and the total value of contributions received, from any trade union, of $250.00 or less but more than $25.00.
srotubirtnoC fo rebmuN snoitubirtnoC )B( yrogetaC lla fo tnuomA latoT
(C) Contributions of $25.00 or less
Note: Report the number of contributors and the total value of contributions received, from any trade union, of $25.00 or less.
srotubirtnoC fo rebmuN snoitubirtnoC )C( yrogetaC lla fo tnuomA latoT
srotubirtnoC fo rebmuN latoT
snoitubirtnoC latoT
(Sum of Categories (A), (B) and (C))
Enter Totals on Part 1(a) Summary of Contributions Line 3.
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
48
E-6.01 REG 2
Schedule: 4. Unincorporated Organizations or Associations
(A) Contributions in excess of $250.00
Note: List below all contributions where the aggregate value of contributions exceeds $250.00.
tnuomA rotubirtnoC fo emaN
List additional contributors on separate sheet provided and affix to this Return.
List Attached Number of Pages Yes or No
srotubirtnoC fo rebmuN snoitubirtnoC )A( yrogetaC lla fo tnuomA latoT
(B) Contributions of $250.00 or less but more than $25.00
Note: Report the number of contributors and the total value of contributions received, from any unincorporated organization or association, of $250.00 or less but more than $25.00.
srotubirtnoC fo rebmuN snoitubirtnoC )B( yrogetaC lla fo tnuomA latoT
(C) Contributions of $25.00 or less
Note: Report the number of contributors and the total value of contributions received, from any unincorporated organization or association, of $25.00 or less.
srotubirtnoC fo rebmuN snoitubirtnoC )C( yrogetaC lla fo tnuomA latoT
srotubirtnoC fo rebmuN latoT
snoitubirtnoC latoT
(Sum of Categories (A), (B) and (C))
Enter Totals on Part 1(a) Summary of Contributions Line 4.
49ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
Schedule: 5. Any other Persons or Groups of Persons
(A) Contributions in excess of $250.00
Note: List below all contributions where the aggregate value of contributions exceeds $250.00.
tnuomA rotubirtnoC fo emaN
List additional contributors on separate sheet provided and affix to this Return.
List Attached Number of Pages Yes or No
srotubirtnoC fo rebmuN snoitubirtnoC )A( yrogetaC lla fo tnuomA latoT
(B) Contributions of $250.00 or less but more than $25.00
Note: Report the number of contributors and the total value of contributions received, from any other person or group of persons, of $250.00 or less but more than $25.00.
srotubirtnoC fo rebmuN snoitubirtnoC )B( yrogetaC lla fo tnuomA latoT
(C) Contributions of $25.00 or less
Note: Report the number of contributors and the total value of contributions received, from any other person or group of persons, of $25.00 or less.
srotubirtnoC fo rebmuN snoitubirtnoC )C( yrogetaC lla fo tnuomA latoT
srotubirtnoC fo rebmuN latoT
snoitubirtnoC latoT
(Sum of Categories (A), (B) and (C))
Enter Totals on Part 1(a) Summary of Contributions Line 5.
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
50
E-6.01 REG 2
Part I
Contributions
(c) Proceeds from Other Sources - Summary
Set out below the aggregate value of net proceeds received by the candidate from the sources as indicated.
tnuomA ecruoS
1. Sales of tickets to or monies paid to each dinner, rally, public meeting and other fund-raising function.
2. Collections made at events mentioned in item 1 above or other events.
3. Sales of pins, buttons, flags, emblems, hats, banners, literature and other materials.
latoT
Enter Total under Schedule: 5. Any Other Persons or Groups of Persons of Part 1(b) Detail of Contributions
Part II
Expenses
Candidate’s Personal Expenses
Set out the total amount of the candidate’s personal expenditures that were paid by him personally and reported to the business manager pursuant to clause 261(2)(b) of the Act. A detailed statement by the candidate supported by supplier documents, bills and proofs of payment of the amounts expensed must be attached to this Return.
Total Amount ________________
Note: Personal expenses of the candidate are not election expenses. Subclause 220(h)(ix) of the Act.
51ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
(a) Candidate’s Campaign Expenses
Set out below the aggregate amount of travel, meal and accommodation expenditures incurred by or on behalf of the candidate and paid by the business manager pursuant to subclause 220(f)(iv) of the Act. Attach particulars of the amounts expensed by the candidate supported by supplier documents, bills and proofs of payment.
Part II
Expenses
(b) Petty Expenses
Set out below the petty expenses paid under the authority of the business manager pursuant to section 259 of the Act. Attach and number consecutively, the statement(s) of particulars of the amounts expensed supported by supplier documents, bills and proofs of payment.
diaP tnuomA sralucitraP .oN .cesnoC
Total
Note: Include only costs associated with expenditures to or within the constituency.
(A) Travel levarT riA elciheV latneR elciheV etavirP
Kilometres travelled at cents per kilometre ixaT/eraF suB )gnikrap ,leuf ,stnacirbul ,ecnarusnI( rehtO
Total of (A)
(B) Accommodation letoM ,letoH ecnediseR yraropmeT
Total of (B)
(C) Living Allowance slaeM
Total of (C)
sesnepxE ngiapmaC s’etadidnaC latoT ))C( dna )B( ,)A( seirogetaC fo muS(
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
52
E-6.01 REG 2
Part
II
Expe
nses
(c)
Hire
of P
rem
ises
Set
out
bel
ow th
e na
me
and
addr
ess
of e
very
per
son,
clu
b, s
ocie
ty, c
ompa
ny a
nd a
ssoc
iatio
n fro
m w
hom
pre
mis
es w
ere
acqu
ired
for t
he p
urpo
se o
f the
ele
ctio
n,
with
a d
escr
iptio
n of
the
prem
ises
so
acqu
ired,
the
purp
ose
for w
hich
and
the
leng
th o
f tim
e du
ring
whi
ch th
e sa
me
wer
e us
ed, t
he a
mou
nt p
aid
to e
ach
and
the
com
mer
cial
val
ue th
ereo
f. A
ttach
sup
plie
r do
cum
ents
, bill
s an
d pr
oofs
of
paym
ent,
num
ber
them
con
secu
tivel
y an
d lis
t th
em in
the
pro
per
colu
mns
be
low
.
Part
II
Expe
nses
(d)
Adv
ertis
ing
Set
out
bel
ow th
e co
st o
f acq
uirin
g th
e rig
ht to
the
use
of ti
me
on th
e fa
cilit
ies
of a
ny b
road
cast
ing
unde
rtaki
ng o
r of a
cqui
ring
the
right
to th
e pu
blic
atio
n of
an
adve
rtise
men
t in
any
new
spap
er o
r m
agaz
ine
circ
ulat
ed i
n th
e pr
ovin
ce.
Set
out
the
nam
e an
d ad
dres
s of
eac
h br
oadc
aste
r and
pub
lishe
r, w
ith a
des
crip
tion
of th
e ad
verti
sing
, the
am
ount
pai
d to
eac
h an
d th
e co
mm
erci
al v
alue
ther
eof.
Atta
ch s
uppl
ier
docu
men
ts, b
ills
and
proo
fs o
f pay
men
t, nu
mbe
r the
m c
onse
cutiv
ely
and
list t
hem
in th
e pr
oper
col
umns
bel
ow.
Com
mer
cial
V
alue
(b)
A
mou
nt P
aid
(a)
Per
iod
for w
hich
us
ed
Pur
pose
for
whi
ch u
sed
Des
crip
tion
of
Pre
mis
es
Add
ress
Nam
e
Con
sec.
No.
Sub
tota
l
Com
mer
cial
V
alue
(b)
Am
ount
Pai
d
(a)
Dat
e of
Issu
e N
ame
of P
ublic
atio
n or
Bro
adca
ster
Add
ress
Nam
e
Con
sec.
No.
Sub
tota
l
Tota
l: (g
reat
er o
f (a)
or (
b))
Tota
l: (g
reat
er o
f (a)
or (
b))
53ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
Part
II
Expe
nses
(e)
Ser
vice
s
Set
out
bel
ow th
e na
me
and
addr
ess
of e
very
per
son,
clu
b, s
ocie
ty, c
ompa
ny a
nd a
ssoc
iatio
n w
ho d
id w
ork
on b
ehal
f of t
he c
andi
date
, with
a d
escr
iptio
n of
the
natu
re o
f the
wor
k do
ne, t
he a
mou
nt p
aid
to e
ach
and
the
com
mer
cial
val
ue th
ereo
f. A
ttach
sup
plie
r doc
umen
ts, b
ills
and
proo
fs o
f pay
men
t, nu
mbe
r the
m
cons
ecut
ivel
y an
d lis
t the
m in
the
prop
er c
olum
ns b
elow
.
Part
II
Expe
nses
(f)
Goo
ds S
uppl
ied
Set
out
bel
ow th
e na
me
and
addr
ess
of e
very
per
son,
clu
b, s
ocie
ty, c
ompa
ny a
nd a
ssoc
iatio
n w
ho p
rovi
ded
good
s, w
ith a
des
crip
tion
of th
e go
ods
supp
lied,
the
amou
nt p
aid
to e
ach
and
the
com
mer
cial
val
ue th
ereo
f. A
ttach
sup
plie
r do
cum
ents
, bill
s an
d pr
oofs
of
paym
ent,
num
ber
them
con
secu
tivel
y an
d lis
t th
em in
the
prop
er c
olum
ns b
elow
.
Com
mer
cial
V
alue
(b)
Am
ount
Pai
d
(a)
Nat
ure
of W
ork
Don
e A
ddre
ssN
ame
Con
sec.
No.
Sub
tota
l
Tota
l: (g
reat
er o
f (a)
or (
b))
Com
mer
cial
V
alue
(b)
Am
ount
Pai
d
(a)
Des
crip
tion
of G
oods
Sup
plie
d(if
onl
y hi
red,
so
stat
e an
d gi
ve d
urat
ion)
A
ddre
ssN
ame
Con
sec.
No.
Sub
tota
l
Tota
l: (g
reat
er o
f (a)
or (
b))
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
54
E-6.01 REG 2
Part
II
Expe
nses
(g)
Trav
el a
nd H
ire o
f Veh
icle
Set
out
bel
ow a
ll tra
velli
ng e
xpen
ses
incu
rred
in c
onju
nctio
n w
ith th
e el
ectio
n, in
clud
ing
rent
al a
ccou
nts
for c
omm
erci
ally
hire
d ve
hicl
es. S
et o
ut th
e am
ount
pai
d to
eac
h an
d th
e co
mm
erci
al v
alue
ther
eof.
Atta
ch s
uppl
ier
docu
men
ts, b
ills
and
proo
fs o
f pa
ymen
t, nu
mbe
r th
em c
onse
cutiv
ely
and
list
them
in t
he
prop
er c
olum
ns b
elow
.
Part
II
Expe
nses
C
laim
s S
till U
npai
d or
Und
er th
e D
irect
ion
of th
e C
hief
Ele
ctor
al O
ffice
r or a
Jud
ge’s
Ord
er
(h)
Und
ispu
ted
Cla
ims
Unp
aid
Set
out
bel
ow th
e na
mes
and
add
ress
es o
f all
pers
ons
who
se u
ndis
pute
d cl
aim
s w
ere
rece
ived
too
late
, or r
emai
ned
unpa
id to
o lo
ng to
be
paya
ble
with
out t
he
dire
ctio
n of
the
Chi
ef E
lect
oral
Offi
cer o
r a
judg
e’s
orde
r and
in re
spec
t of w
hich
suc
h a
dire
ctio
n or
ord
er h
as b
een,
or i
s ab
out t
o be
app
lied
for,
toge
ther
with
pa
rticu
lars
of t
he n
atur
e of
the
clai
m, t
he a
mou
nt a
nd th
e co
mm
erci
al v
alue
ther
eof.
Tota
l: (g
reat
er o
f (a)
or (
b))
Com
mer
cial
V
alue
(b)
Am
ount
Pai
d
(a)
Nat
ure
of C
laim
A
ddre
ssN
ame
Con
sec.
No.
Sub
tota
l
Com
mer
cial
V
alue
(b)
Am
ount
of
Cla
im
(a)
If pa
id, d
ate
of d
irect
ion,
or
der o
r jud
gmen
t
Pai
d or
U
npai
d
Dat
eR
ecei
ved
N
atur
e of
Cla
im
Add
ress
Nam
e
Sub
tota
l
Tota
l: (g
reat
er o
f (a)
or (
b))
55ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
(i)
Dis
pute
d C
laim
s U
npai
d
In a
dditi
on,
set
out
belo
w t
he d
ispu
ted
and
unpa
id c
laim
s, t
he n
ames
and
add
ress
es o
f th
e cl
aim
ants
, th
e na
ture
of
the
clai
ms
resp
ectiv
ely,
the
am
ount
and
c o
mm
erci
al v
alue
ther
eof.
Com
mer
cial
V
alue
(b)
Am
ount
of
Cla
im
(a)
Cha
ract
er o
f Dis
pute
d C
laim
A
ddre
ssN
ame
Sub
tota
l
Tota
l: (g
reat
er o
f (a)
or (
b))
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
56
E-6.01 REG 2
Statement of Contribution Corporation, Trust Fund or Constituency Association
Contributor Name of Corporation, Trust Fund or Constituency Association
Address
Postal Code
Telephone Number ( )
I, the undersigned,
having authorization to act for the , Name of Corporation, Trust Fund or Constituency Association
submit the following statement of the individual sources and amounts making up the contribution (or the
fund) of this corporation, trust fund or constituency association, and further that the total amount indicated is
the amount contributed to Name of Candidate
a candidate at the election about to be held in the constituency of .
nosreP dezirohtuA fo erutangiS etaD
dleH noitisoP
I, the undersigned, business manager for Name of Candidate
certify that the following record of contributions is a true and correct copy of the statement of contribution
received by the above-named contributor pursuant to The Election Act, 1996 (subsection 240(6)).
reganaM ssenisuB fo erutangiS
57ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
Sources and Amounts
(Check one) This is a record of individual sources and amounts making up the contribution.
This is a record of individual sources and amounts making up the fund.
(A) Contributions in excess of $250.00
Note: List below, the aggregate value of contributions received in a year from any person who contributed in excess of $250.00 whose funds were used toward the making of this contribution.
tnuomA rotubirtnoC fo emaN
List additional contributors on separate sheet provided and affix to this record.
List Attached Number of Pages Yes or No
snoitubirtnoC )A( yrogetaC lla fo tnuomA latoT
(B) Contributions of $250.00 or less
Note: Report the total value of contributions received in a year from any person who contributed $250.00 or less whose funds were used toward the making of this contribution.
snoitubirtnoC )B( yrogetaC lla fo tnuomA latoT
(C) Interest or Investment Income
Note: Report the total value of interest or investment income received in a year which was used toward the making of this contribution.
snoitubirtnoC )C( yrogetaC lla fo tnuomA latoT
Total Contributions
(Sum of Categories (A), (B) and (C))
Enter Totals under applicable Schedule of Part 1(b) Detail of Contributions
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
58
E-6.01 REG 2
Statement of Contribution Registered Party
Contributor Name of Registered Party
Address
Postal Code
Telephone Number ( )
The following is a statement of the individual sources and amounts making up the contribution of this registered party, and further that the total amount indicated is the amount contributed to
, Name of Candidate
a candidate at the election about to be held in the constituency of .
etaD
I, the undersigned, business manager for Name of Candidate
certify that the following record of contributions is a true and correct copy of the statement of contribution received by the above-named contributor pursuant to The Election Act, 1996 (subsection 240(7)).
Signature of Business Manager
59ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
17 Feb 2006 SR 6/2006 s4.
Sources and Amounts
(A) Contributions in excess of $250.00
Note: List below, the aggregate value of contributions received in a year from any person who contributed in excess of $250.00 whose funds were used toward the making of this contribution.
tnuomA rotubirtnoC fo emaN
List additional contributors on separate sheet provided and affix to this record.
List Attached Number of Pages Yes or No
snoitubirtnoC )A( yrogetaC lla fo tnuomA latoT
(B) Contributions of $250.00 or less
Note: Report the total value of contributions received in a year from any person who contributed $250.00 or less whose funds were used toward the making of this contribution.
snoitubirtnoC )B( yrogetaC lla fo tnuomA latoT
Total Contributions
(Sum of Categories (A) and (B))
Enter Total on Schedule: 4. Unincorporated Organizations or Associations of snoitubirtnoC fo liateD )b(1 traP
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
60
E-6.01 REG 2
FORM WW[Clause 261(1)(c) of the Act]
Oath or Declaration of Business Manager of a Candidate
I ________________________________________________ of ________________________________________________ ,being the business manager of ______________________________________________________________, a candidateat the election held on the _____________ day of ________________________ , ____________ of a member of theLegislative Assembly of Saskatchewan,
solemnly declare that I have examined the Return of Election Expenses, along with any attached certifiedstatements, to be transmitted to the Returning Officer at that election and now shown to me by the officer beforewhom this declaration is made, and that to the best of my knowledge and belief that return and any attachedcertified statements are correct;
and I further solemnly declare that, except as appears from that Return, I have not and to the best of my knowledgeand belief no other person, nor any club, society, company or association has on behalf of the candidate made anypayment, or given, promised or offered any reward, office, employment or valuable consideration, or incurred anyliability on account of or with respect to the conduct or management of the election;
and I further solemnly declare that I have received from the candidate, the sum of (insert NO if the fact is so)
_______________ dollars and no more for the purposes of the election, and that, except as specified in the Returnmade by me, no money, security or equivalent for money has been paid, advanced, given or deposited by anyone tome or in my hands, or to the best of my knowledge and belief, to or in the hands of any other person for the purposeof defraying any expenses incurred on behalf of the candidate on account of or with respect to the conduct ormanagement of the election;
and I make this solemn declaration conscientiously believing it to be true, and knowing that it is of the same forceand effect as if made under oath, and by virtue of the Canada Evidence Act.
____________________________________________________Signature of Business Manager
Signed and declared before me by the above-named business manager at ___________________________________in the Province of Saskatchewan, on the ____________ day of __________________ , ___________ .
____________________________________________________Person Authorized to Administer Oaths inSaskatchewan
2 Jan 1998 cE-6.01 Reg 2.
61ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
FORM XX[Subsection 261(5) of the Act]
Candidate’s Oath or Declaration as to Expenses
I, ____________________________________________________________________________________________ , whoseaddress is __________________________________________________________________________________ and whoseoccupation is ____________________________________________________ , having been a candidate at the electionof a member to serve in the Legislative Assembly of Saskatchewan for the constituency of ___________________ ,held on the _____________________ day of _______________________ , _________ , solemnly declare that I have
(insert date of poll)
examined the Return of Election Expenses, along with any certified statements, transmitted or about to betransmitted by my business manager to the Returning Officer at the election, a copy of which Return is nowshown by me and signed by the officer before whom this declaration is made, and that to the best of my knowledgeand belief that Return and any attached certified statements are correct;
and I further solemnly declare that, except as appears from that Return, I have not, and to the best of my knowledgeand belief no person, nor any club, society, company or association has, on my behalf, made any payment, or given,promised or offered any reward, office, employment or valuable consideration, or incurred any liability on accountof or with respect to the conduct or management of the election;
and I further solemnly declare that I have paid to my business manager, the sum of (insert NO if the fact is so)
_________________ dollars and no more for the purpose of the election, and that, except as specified in the Return,no money, security or equivalent for money has to my knowledge or belief been paid, advanced, given or depositedby anyone to or in the hands of my business manager or any other person for the purpose of defraying anyexpenses incurred on my behalf on account of or with respect to the conduct or management of the election;
and I further solemnly declare that I will not, except so far as I may be permitted by law, at any future time makeor be party to the making or giving of any payment, reward, office employment or valuable consideration for thepurpose of defraying any such expenses as last mentioned, or provide or be party to the providing of any money,security or equivalent for the purpose of defraying any such expenses;
and I make this solemn declaration conscientiously believing it to be true, and knowing that it is of the same forceand effect as if made under oath, and by virtue of the Canada Evidence Act.
____________________________________________________Signature of Candidate
Signed and declared before me by the above-named candidate at ___________________________________________in the Province of Saskatchewan, on the ____________ day of ________________________ , _________ .
____________________________________________________Person Authorized to Administer Oaths inSaskatchewan
2 Jan 1998 cE-6.01 Reg 2.
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
62
E-6.01 REG 2
(Those categories of payments that arereported as not being made shall be omittedfrom the advertisement)
FORM YY[Subsection 261(8) of the Act]
Summary of Candidate Election Expenses
Constituency of ________________________________________________________________________________________
I, _____________________________________________ of ____________________________________________________(Name of Returning Officer () Residential Address)
in the Province of Saskatchewan, Returning Officer for the Constituency of ________________________________ ,set out below a summary of the election expenses incurred by ______________________________________________
(Name of Candidate)being (a representative of ___________________________________________________________________ and a) (or in
(Name of Registered Political Party)the case of an independent candidate insert (an Independent)) candidate at the election of a member to serve inthe Legislative Assembly of Saskatchewan held on ________________________________________ ,_____________ .
(Date of Poll)The sums stated are taken from the above-named Candidate’s Return of Election Expenses received by me on___________________________________ , __________ . Any voter wishing to do so may examine the above-namedcandidate’s complete return of election expenses, a copy of which shall remain in my possession for a period of sixmonths ending on __________________ , _________ .
AmountReceipts
Receipts, loans, contributions,donation of goods and services,proceeds from fund-raising events and saleof tickets, pins, buttons, etc.
PaymentsCandidate’s Personal Expenses
Candidate’s Campaign Expenses
Petty Expenses
Hire of Premises
Advertising
Services
Goods Supplied
Travel and Hire of Vehicles
Undisputed Claims Unpaid
Disputed Claims Still Unpaid
Dated at ______________ , Saskatchewan, this ___________ day of __________________ , ___________ .
_____________________________________________________Returning Officer
2 Jan 1998 cE-6.01 Reg 2.
63ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
FORM ZZ[Section 251 of the Act]
Registered Political Party’sReturn of Election Expenses
On Behalf of
_______________________________________________________________________________________________________Name of Registered Political Party
Return
I, _______________________________________________ of __________________________________________________sserddAemaN
_______________________________________________________________________________________________________Mailing Address (if different from the residential address)
Telephone Number Residence ( ) ________________________ Business ( ) ______________________
in the Province of Saskatchewan, being the chief official agent of the above-named registered political party, makethe following Return respecting the election expenses of the said party, which were incurred during the electionheld on the ____________ day of __________________ , _______ .
___________________________________________________Signature of Chief Official Agent
___________________________________________________Date
Note
1. This Return must be transmitted to the Chief Electoral Officer within six (6) months after polling day at theelection to which it relates.Subsection 251(1)
2. This Return must be accompanied by the auditor’s report to the chief official agent of the party on theinformation given in this Return.Subsection 251(1)
3. The commercial value of goods and services donated (other than volunteer labour or goods valued at $25.00 orless), and the difference between the amount paid and the commercial value of goods and services provided, areconsidered to be election expenses. If the total of “commercial value” is greater than the total of “amount paid” itis the larger of the two figures that is used in the calculation of election expenses incurred by the registeredpolitical party. See definition of “commercial value”, subsection 220(c).
4. A statement, signed and receipted, by the donor and by the chief official agent, supported by a verificationfrom an independent commercial source of the amount expensed must be submitted when making claim ofcommercial value as an election expense.Subsections 220(c) and 251(2)(b)
5. All payments of more than $25.00 must be accompanied by a supplier document that states the particulars ofthe election expense and by a receipt or cancelled cheque that provides proof of payment. The supplier documentsand proofs of payment must be submitted with this Return.Section 244Subsection 251(2)(b)
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
64
E-6.01 REG 2
Summary of Election Expenses
_______________$sesnepxE ytteP)a(
_______________$sesimerP fo eriH)b(
_______________$gnisitrevdA)c(
_______________$secivreS)d(
_______________$deilppuS sdooG)e(
(f) Travel and Hire of Vehicle $ _______________
(g) Undisputed Claims Unpaid $ _______________
____________$SESNEPXE LATOT
(h) Disputed Claims Unpaid $ _______________
Note: Total Expenses (excluding (g) above) is used for the calculation of reimbursement.
Expenses
(a) Petty Expenses
Set out below the petty expenses paid under the authority of the chief official agent pursuant to section 248. Attachand number consecutively, the statement(s) of particulars of the amounts expensed supported by supplieddocuments, bills and proofs of payment.
diaP tnuomAsralucitraP.oN .cesnoC
Total
65ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
Exp
ense
s
(b)
Hir
e of
Pre
mis
es
Set
out
bel
ow t
he n
ame
and
addr
ess
of e
very
per
son,
clu
b, s
ocie
ty, c
ompa
ny a
nd a
ssoc
iati
on f
rom
who
m p
rem
ises
wer
e ac
quir
ed f
or t
he p
urpo
se o
f th
eel
ecti
on, w
ith
a de
scri
ptio
n of
the
pre
mis
es s
o ac
quir
ed, t
he p
urpo
se fo
r w
hich
and
the
leng
th o
f tim
e du
ring
whi
ch t
he s
ame
wer
e us
ed, t
he a
mou
nt p
aid
to e
ach
and
the
com
mer
cial
val
ue th
ereo
f. A
ttac
h su
ppli
er d
ocum
ents
, bil
ls a
nd p
roof
s of
pay
men
t, n
umbe
r th
em c
onse
cuti
vely
an
d li
st th
em in
the
prop
erco
lum
ns b
elow
.
laicrem
moC
tnuom
Arof doire
Prof esopru
Pfo noitpircse
D.cesno
C No.
Nam
eA
ddre
ss P
rem
ises
whi
ch u
sed
whi
ch u
sed
Pai
d
Val
ue
Sub
tota
l(a
)(b
)
Tota
l:(g
reat
er o
f (a)
or
(b))
Exp
ense
s
(c)
Adv
erti
sing
Set
out
bel
ow th
e co
st o
f acq
uiri
ng th
e ri
ght t
o th
e us
e of
tim
e on
the
faci
liti
es o
f any
bro
adca
stin
g un
dert
akin
g or
of a
cqui
ring
the
righ
t to
the
publ
icat
ion
of a
n ad
vert
isem
ent
in a
ny n
ewsp
aper
or
mag
azin
e ci
rcul
ated
in t
he p
rovi
nce.
Set
out
the
nam
e an
d ad
dres
s of
eac
h br
oadc
aste
r an
d pu
blis
her,
wit
h a
desc
ript
ion
of t
he a
dver
tisi
ng, t
he a
mou
nt p
aid
to e
ach
and
the
com
mer
cial
val
ue t
here
of.
Att
ach
supp
lier
doc
umen
ts, b
ills
and
pro
ofs
of p
aym
ent,
num
ber
them
con
secu
tive
ly a
nd li
st t
hem
in t
he p
rope
r co
lum
ns b
elow
.
laicrem
moC
tnuom
Afo eta
Dnoitacilbu
P fo ema
N.cesno
C
N
o.N
ame
Add
ress
or
Bro
adca
ster
Iss
ue P
aid
V
alue
Sub
tota
l(a
)(b
)
Tota
l:(g
reat
er o
f (a)
or
(b))
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
66
E-6.01 REG 2
Exp
ense
s
(d)
Ser
vice
s
Set
out
bel
ow t
he n
ame
and
addr
ess
of e
very
per
son,
clu
b, s
ocie
ty, c
ompa
ny a
nd a
ssoc
iati
on w
ho d
id w
ork
on b
ehal
f of t
he r
egis
tere
d po
liti
cal p
arty
, wit
ha
desc
ript
ion
of t
he n
atur
e of
the
wor
k do
ne, t
he a
mou
nt p
aid
to e
ach
and
the
com
mer
cial
val
ue t
here
of.
Att
ach
supp
lier
doc
umen
ts, b
ills
and
pro
ofs
o fpa
ymen
t, nu
mbe
r th
em c
onse
cuti
vely
and
list
the
m in
the
pro
per
colu
mns
bel
ow.
Con
sec.
Am
ount
Com
mer
cial
eulaV
diaP eno
D kroW fo eruta
Nsserdd
Ae
maN
.oN
Sub
tota
l(a
)(b
)
Tota
l:(g
reat
er o
f (a)
or
(b))
Exp
ense
s
(e)
Goo
ds S
uppl
ied
Set
out
bel
ow th
e na
me
and
addr
ess
of e
very
per
son,
clu
b, s
ocie
ty, c
ompa
ny o
r as
soci
atio
n w
ho p
rovi
ded
good
s, w
ith
a de
scri
ptio
n of
the
good
s su
ppli
ed, t
heam
ount
pai
d to
eac
h an
d th
e co
mm
erci
al v
alue
ther
eof.
Att
ach
supp
lier
doc
umen
ts, b
ills
and
pro
ofs
of p
aym
ent,
num
ber
them
con
secu
tive
ly a
nd li
st th
emin
the
pro
per
colu
mns
bel
ow.
laicrem
moC
tnuom
Adeilppu
S sdooG fo noitpircse
D.cesno
Ceula
V dia
P )noitarud evig dna etats os ,derih ylno fi(
sserddA
ema
N.o
N
Sub
tota
l(a
)(b
)
Tota
l:(g
reat
er o
f (a)
or
(b))
67ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
Exp
ense
s
(f)
Tra
vel a
nd H
ire
of V
ehic
le
Set
out
bel
ow a
ll t
rave
llin
g ex
pens
es i
ncur
red
in c
onju
ncti
on w
ith
the
elec
tion
, inc
ludi
ng r
enta
l ac
coun
ts f
or c
omm
erci
ally
hir
ed v
ehic
les.
S
et o
ut t
heam
ount
pai
d to
eac
h an
d th
e co
mm
erci
al v
alue
ther
eof.
Att
ach
supp
lier
doc
umen
ts, b
ills
and
pro
ofs
of p
aym
ent,
num
ber
them
con
secu
tive
ly a
nd li
st th
emin
the
pro
per
colu
mns
bel
ow.
Con
sec.
Am
ount
Com
mer
cial
eulaV dia
P mial
C fo erutaN
sserddA
ema
N.o
N
Sub
tota
l(a
)(b
)
Tota
l:(g
reat
er o
f (a)
or
(b))
Exp
ense
s
Cla
ims
Sti
ll U
npai
d or
Und
er t
he D
irec
tion
of t
he C
hief
Ele
ctor
al O
ffic
er o
r a
Judg
e’s
Ord
er
(g)
Und
ispu
ted
Cla
ims
Unp
aid
Set
out
bel
ow t
he n
ames
and
add
ress
es o
f all
per
sons
who
se u
ndis
pute
d cl
aim
s w
ere
rece
ived
too
late
, or
rem
aine
d un
paid
too
lon
g to
be
paya
ble
wit
hout
the
dire
ctio
n of
the
Chi
ef E
lect
oral
Off
icer
or
a ju
dge’
s or
der
and
in r
espe
ct o
f w
hich
suc
h a
dire
ctio
n or
ord
er h
as b
een,
or
is a
bout
to
be a
ppli
ed f
or,
toge
ther
wit
h p
arti
cula
rs o
f the
nat
ure
of t
he c
laim
, the
am
ount
and
the
com
mer
cial
val
ue t
here
of.
Dat
e
Pa
idIf
pai
d, d
ate
of d
irec
tion
,A
mou
nt o
fC
omm
erci
alN
ame
Add
ress
Nat
ure
of C
laim
Rec
eive
dor
Upd
aid
or
der
or ju
dgm
ent
C
laim
V
alue
Sub
tota
l(a
)(b
)
Tota
l:(g
reat
er o
f (a)
or
(b))
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
68
E-6.01 REG 2
(h)
Dis
pute
d C
laim
s U
npai
d
In a
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2 Jan 1998 cE-6.01 Reg 2.
69ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
FORM AAA[Clause 251(1)(c) of the Act]
Oath or Declaration of a Chief Official Agent of aRegistered Political Party
I, __________________________________________________ of _______________________________________________ ,being Chief Official Agent of _________________________________________________________ , being a registeredpolitical party, operating during an election held in Saskatchewan on the ___________________________ day of__________________________ , ____________ ,
solemnly declare that I have examined the Return of Election Expenses to be transmitted to the Chief ElectoralOfficer, and now shown to me by the officer before whom this declaration is made, and that to the best of myknowledge and belief that Return is correct;
and I further solemnly declare that except as appears from that Return, I have not and to the best of my knowl-edge and belief no other person, nor any club, society, company or association has on behalf of the registeredpolitical party made any payment, or given, promised or offered any reward, office, employment or valuableconsideration, or incurred any liability on account of or with respect to the conduct or management of the election;
and I make this solemn declaration conscientiously believing it to be true, and knowing that it is of the same forceand effect as if made under oath, and by virtue of the Canada Evidence Act.
____________________________________________________Signature of Chief Official Agent
Signed and declared before me by the above-named Chief Official Agent at __________________________________in the Province of Saskatchewan, on the __________ day of _____________________ , _________ .
____________________________________________________Person Authorized to Administer Oaths inSaskatchewan
2 Jan 1998 cE-6.01 Reg 2.
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
70
E-6.01 REG 2
FORM BBB[Section 250 of the Act]
Registered Political Party’sFiscal Period Return
On Behalf of the
_______________________________________________________________________________________________________Name of Registered Political Party
Return
I, ______________________________________________ of ___________________________________________________sserddAemaN
_______________________________________________________________________________________________________Mailing Address (if different from the residential address)
Telephone Number Residence ( ) ______________________ Business ( ) ____________________
in the Province of Saskatchewan, being the chief official agent of the above-named registered political partymake the following Return respecting the fiscal period of the party which commenced on the ________________day of ____________________________ , ___________ , and which terminated on the __________________ day of__________________________________ , ___________ .
_______________________________________ ______________________________________________________Signature of Chief Official Agent Date
Note
1. This Return must be transmitted to the Chief Electoral Officer within four (4) months after the end of thefiscal period to which it relates.Subsection 250(4)
2. This Return must be accompanied by the auditor’s report to the chief official agent of the party on theinformation given in this Return.Subsection 250(4)
3. The value of goods and services provided is the “Commercial Value” as defined in subsection 220(c).
71ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
Part I
Contributions
(a) Summary of Contributions
List below, by class of contributor, the aggregate amounts of (A) contributions in excess of $250.00, (B) contributionsof $250.00 or less but more than $25.00, and (C) contributions of $25.00 or less, and the number of contributorsof each class who, in the fiscal period, have provided money, goods or services for the use of the registeredpolitical party by way of a gift, loan, advance, deposit, or other form of assistance (includes goods or servicesdonated or provided at other than their true value).
Number of Value ofsnoitubirtnoCsrotubirtnoCrotubirtnoC fo ssalC
1. Individuals
2. Corporations
3. Trade Unions
4. Unincorporated Organizations or Associations
5. Any other Persons or Groups of Persons
Totals
Note: Amounts received in respect of membership fees or dues are deemed to be contributions (s. 250(5)).
Part I
Contributions
(b) Detail of Contributions
Contributions include money provided to or on behalf of the registered political party without compensation fromthe registered political party and includes donations in kind and membership fees or dues paid to the registeredpolitical party.
Detail of the name of and total amount received from each contributor included in classes 1 to 5 in Part (a) whohave provided money, goods or services by way of a gift, loan, advance, deposit or other form of assistance mustbe reported in the aggregate by classification in the appropriate schedule. Such contributions are to be identifiedin one of three categories: (A) contributions in excess of $250.00, (B) contributions of $250.00 or less but morethan $25.00, and (C) contributions of $25.00 or less. The sum of the categories should reflect the total contributionsreceived, in the fiscal period, for the use of the registered political party in each classification schedule.
Where a corporation, trust fund or constituency association of a registered political party makes a contribution,pursuant to Section 240(6) of The Election Act, 1996, each such contribution must be accompanied by a statementwhich sets out the name of the person who authorized the contribution on behalf of the corporation, trust fund orconstituency association, and the name of and the amount contributed by, each person who made a contributionin excess of $250.00 in a year and whose contribution was used to make up the funds contributed by the corporation,trust fund or constituency association.
Where a registered party makes a contribution, pursuant to Section 240(7) of The Election Act, 1996, each suchcontribution must be accompanied by a statement which sets out the name of and the amount contributed by,each person who made a contribution in excess of $250.00 in a year and whose contribution was used to make upthe funds contributed by the registered party.
A true and correct copy, certified by the chief official agent, for each such statement of contribution receivedpursuant to subsections 240(6) and (7), must be affixed to this Return (s.250(3)).
Revenue received by a registered political party, during the fiscal period, from fund-raising activities, meetingsand sales of material of a promotional nature are deemed contributions. The total net proceeds from each sourceindicated must be recorded and, in the aggregate, reported in this Return.
The value of donations in kind must be recorded and included as a contribution received by the chief officialagent where claimed as an election expense. Accordingly, commercial value is an election expense and a contributionconcurrently.
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
72
E-6.01 REG 2
Schedule: 1. Individuals
(A) Contributions in excess of $250.00
Note: List below, all contributions where during the fiscal period the aggregate value of contributions exceeded$250.00.
tnuomArotubirtnoC fo emaN
List additional contributors on separate sheet provided and affix to this Return.
List Attached ___________________ Number of Pages _______________Yes or No
____________srotubirtnoC fo rebmuN
Total Amount ______________________snoitubirtnoC )A( yrogetaC lla fo
(B) Contributions of $250.00 or less but more than $25.00
Note: Report the number of contributors and the total value ofcontributions received, during the fiscal period from anyindividual, of $250.00 or less but more than $25.00.
____________srotubirtnoC fo rebmuN
______________________snoitubirtnoC )B( yrogetaC lla fo tnuomA latoT
(C) Contributions of $25.00 or less
Note: Report the number of contributors and thetotal value of contributions received during thefiscal period, from any individual, of $25.00 or less.
____________srotubirtnoC fo rebmuN
______________________snoitubirtnoC )C( yrogetaC lla fo tnuomA latoT
Total Number of Contributors
Total Contributions
(Sum of Categories (A), (B) and (C))
Enter Totals on Part 1(a) Summary of ContributionsLine 1.
73ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
Schedule: 2. Corporations
(A) Contributions in excess of $250.00
Note: List below, all contributions where during the fiscal period the aggregate value of contributions exceeded$250.00.
tnuomArotubirtnoC fo emaN
List additional contributors on separate sheet provided and affix to this Return.
List Attached ___________________ Number of Pages _______________Yes or No
____________srotubirtnoC fo rebmuN
Total Amount ______________________snoitubirtnoC )A( yrogetaC lla fo
(B) Contributions of $250.00 or less but more than $25.00
Note: Report the number of contributors and thetotal value of contributions received duringthe fiscal period, from any corporation,of $250.00 or less but more than $25.00.
____________srotubirtnoC fo rebmuN
______________________snoitubirtnoC )B( yrogetaC lla fo tnuomA latoT
(C) Contributions of $25.00 or less
Note: Report the number of contributors and thetotal value of contributions received duringthe fiscal period, from any corporation, of$25.00 or less.
____________srotubirtnoC fo rebmuN
______________________snoitubirtnoC )C( yrogetaC lla fo tnuomA latoT
Total Number of Contributors
Total Contributions
(Sum of Categories (A), (B) and (C))
Enter Totals on Part 1(a) Summary of ContributionsLine 2.
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
74
E-6.01 REG 2
Schedule: 3. Trade Unions
(A) Contributions in excess of $250.00
Note: List below, all contributions where during the fiscal period the aggregate value of contributions exceeded$250.00.
tnuomArotubirtnoC fo emaN
List additional contributors on separate sheet provided and affix to this Return.
List Attached ___________________ Number of Pages _______________Yes or No
____________srotubirtnoC fo rebmuN
Total Amount ______________________snoitubirtnoC )A( yrogetaC lla fo
(B) Contributions of $250.00 or less but more than $25.00
Note: Report the number of contributors and thetotal value of contributions received during thefiscal period, from any trade union, of $250.00or less but more than $25.00.
____________srotubirtnoC fo rebmuN
______________________snoitubirtnoC )B( yrogetaC lla fo tnuomA latoT
(C) Contributions of $25.00 or less
Note: Report the number of contributors and thetotal value of contributions received during thefiscal period, from any trade union, of $25.00 or less.
____________srotubirtnoC fo rebmuN
______________________snoitubirtnoC )C( yrogetaC lla fo tnuomA latoT
Total Number of Contributors
Total Contributions
(Sum of Categories (A), (B) and (C))
Enter Totals on Part 1(a) Summary of ContributionsLine 3.
75ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
Schedule: 4. Unincorporated Organizations and Associations
(A) Contributions in excess of $250.00
Note: List below, all contributions where during the fiscal period the aggregate value of contributions exceeds$250.00.
tnuomArotubirtnoC fo emaN
List additional contributors on separate sheet provided and affix to this Return.
List Attached ___________________ Number of Pages _______________Yes or No
____________srotubirtnoC fo rebmuN
Total Amount ______________________snoitubirtnoC )A( yrogetaC lla fo
(B) Contributions of $250.00 or less but more than $25.00
Note: Report the number of contributors and thetotal value of contributions received during the fiscalperiod, from any unincorporated organization orassociation, of $250.00 or less but more than $25.00.
____________srotubirtnoC fo rebmuN
______________________snoitubirtnoC )B( yrogetaC lla fo tnuomA latoT
(C) Contributions of $25.00 or less
Note: Report the number of contributors and the total valueof contributions received during the fiscal period, fromany unincorporated organization or association,of $25.00 or less.
____________srotubirtnoC fo rebmuN
______________________snoitubirtnoC )C( yrogetaC lla fo tnuomA latoT
Total Number of Contributors
Total Contributions
(Sum of Categories (A), (B) and (C))
Enter Totals on Part 1(a) Summary of ContributionsLine 4.
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
76
E-6.01 REG 2
Schedule: 5. Any other Persons or Groups of Persons
(A) Contributions in excess of $250.00
Note: List below, all contributions where during the fiscal period the aggregate value of contributions exceeded$250.00.
tnuomArotubirtnoC fo emaN
List additional contributors on separate sheet provided and affix to this Return.
List Attached ___________________ Number of Pages _______________Yes or No
____________srotubirtnoC fo rebmuN
Total Amount ______________________snoitubirtnoC )A( yrogetaC lla fo
(B) Contributions of $250.00 or less but more than $25.00
Note: Report the number of contributors and the total valueof contributions received during the fiscal period, fromany other persons or groups of persons, of $250.00 orless but more than $25.00.
____________srotubirtnoC fo rebmuN
______________________snoitubirtnoC )B( yrogetaC lla fo tnuomA latoT
(C) Contributions of $25.00 or less
Note: Report the number of contributors and the total valueof contributions received during the fiscal period, fromany other persons or groups of persons, of $25.00 or less.
____________srotubirtnoC fo rebmuN
______________________snoitubirtnoC )C( yrogetaC lla fo tnuomA latoT
Total Number of Contributors
Total Contributions
(Sum of Categories (A), (B) and (C))
Enter Totals on Part 1(a) Summary of ContributionsLine 5.
77ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
Part I
Contributions
(c) Proceeds from Other Sources – Summary
Set out below the aggregate value of net proceeds received by the registered political party during the fiscalperiod from the sources as indicated.
tnuomAecruoS
1. Sales of tickets to or monies paid to each dinner, rally,public meeting and other fund-raising function.
2. Collections made at events mentioned in item 1 above or otherevents.
3. Sales of pins, buttons, flags, emblems, hats, banners, literatureand other materials.
Total
Enter Total on Schedule: 5. Any other Persons or Groups of Persons of Part 1(b) Detail of Contributions
Part I
Other Revenue
(a) Income from Other Sources
Set out below the total value of income received by the registered political party during the fiscal period from thesources as indicated.
tnuomAecruoS
1. Election Expenses/Auditor Reimbursement(s)
2. Candidates’ Excess Contributions
3. Interest/Investment Income
4. Other (Provide Details)
Total
(b) Cash on Hand
Set out the amount of money, securities or the equivalent of money thatthe registered political party has on hand at the end of the fiscal period.
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
78
E-6.01 REG 2
Part II
Expenditures
(a) Operating Expenditures
Set out below the total operating expenses of the registered political party during the fiscal period.
Note: Omit election expenses incurred which related to an election held during the fiscal period.
tnuomAsesnepxE gnitarepO
1. Salaries, Wages and Employee Benefits
2. Travelling Expenses
3. Conventions and Meetings
4. Rental (Premises, Equipment and Utilities)
5. Advertising (Particulars to be set out in Part II(b))
6. Printing, Stationery and Supplies
7. Postage
8. Legal and Audit Fees
9. Interest
10. Taxes (Property)
11. Other (Provide Details)
Total
Part II
Expenditures
(b) Advertising Expenditures
Set out below the particulars of expenditures on advertising of the registered political party during the fiscalperiod.
Note: Subsection 243(4) limits the amount of money a registered party can spend during a fiscal period onadvertising. This limit does not apply to election expenses which may be lawfully incurred by a registeredpolitical party.
Name of Broadcaster or Publisher Date of Advertisement Amount
Total
79ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
Part II
Expenditures
(c) All Other Expenditures
Set out below any transfer of monies or other expenses incurred by the registered political party during thefiscal period.
tnuomAserutidnepxE rehtO
1. Transfer to Provincial Constituencies and Candidates
2. Transfer to Federal Electoral District
3. Transfer to Registered Party
4.
5.
6.
7.
8.
9.
Total
Statement of ContributionRegistered Party
Contributor ___________________________________________________________________________________________Name of Registered Party
Address _______________________________________________________________________________________________
_______________________________________________________________________________________________________Postal Code
Telephone Number ( ) ________________________
The following is a statement of the individual sources and amounts making up the contribution of this registeredparty, and further that the total amount indicated is the amount contributed to the ________________________ ,a registered political party in the Province of Saskatchewan.
___________________________________Date
I, the undersigned, chief official agent of the _____________________________________________________________Name of Registered Political Party
certify that the following record of contributions is a true and correct copy of the statement of contributionreceived by the above-named contributor pursuant to The Election Act, 1996 (s. 240(7)).
______________________________________________________Signature of Chief Official Agent
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
80
E-6.01 REG 2
Sources and Amounts
(A) Contributions in excess of $250.00
Note: List below, the aggregate value of contributions received in a year from those who contributed in excess of$250.00 whose funds were used toward the making of this contribution.
tnuomArotubirtnoC fo emaN
List additional contributors on separate sheet provided and affix to this record.
List Attached ___________________ Number of Pages _______________Yes or No
______________________snoitubirtnoC )A( yrogetaC fo tnuomA latoT
(B) Contributions of $250.00 or less
Note: Report the total value of contributions received in a yearfrom those who contributed $250.00 or less whose fundswere used toward the making of this contribution.
______________________snoitubirtnoC )B( yrogetaC fo tnuomA latoT
Total Contribution
(Sum of Categories (A) and (B))
Enter Total on Schedule: 4. Unincorporated Organizationsor Associations of Part 1(b) Detail of Contributions
81ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
Statement of ContributionCorporation, Trust Fund or Constituency Association
Contributor __________________________________________________________________________________________ Name of Corporation, Trust Fund or Constituency Association of a Registered Political Party
Address ______________________________________________________________________________________________
______________________________________________________________________________________________________Postal Code
Telephone Number ( ) _____________________
I, the undersigned, having authorization to act for the
_____________________________________________________________________________________________________ ,Name of Corporation, Trust Fund or Constituency Association of a Registered Political Party
submit the following statement of the individual sources and amounts making up the contribution (or the fund)of this corporation, trust fund or constituency association, and further that the total amount indicated is theamount contributed to the ____________________________________________________________________________ ,a registered political party in the Province of Saskatchewan.
______________________________________ _____________________________________________________Date Signature of Authorized Person
_____________________________________________________Position Held
I, the undersigned, chief official agent of the ____________________________________________________________Name of Registered Political Party
certify that the following record of contributions is a true and correct copy of the statement of contributionreceived by the above-named contributor pursuant to The Election Act, 1996 (s. 240(6)).
_____________________________________________________Signature of Chief Official Agent
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
82
E-6.01 REG 2
Sources and Amounts
(Check one) This is a record of individual sources and amounts making up the contribution.This is a record of individual sources and amounts making up the fund.
(A) Contributions in excess of $250.00
Note: List below, the aggregate value of contributions received in a year from those who contributed in excess of$250.00 whose funds were used toward the making of this contribution.
tnuomArotubirtnoC fo emaN
List additional contributors on separate sheet provided and affix to this record.
List Attached ___________________ Number of Pages _______________Yes or No
______________________snoitubirtnoC )A( yrogetaC fo tnuomA latoT
(B) Contributions of $250.00 or less
Note: Report the total value of contributions received in a yearfrom those who contributed $250.00 or less whose fundswere used toward the making of this contribution.
______________________snoitubirtnoC )B( yrogetaC fo tnuomA latoT
(C) Interest or Investment Income
Note: Report the total value of interest or investment incomereceived in a year which was used toward the makingof this contribution.
______________________snoitubirtnoC )C( yrogetaC fo tnuomA latoT
Total Contribution
(Sum of Categories (A), (B) and (C))
Enter Total under applicable Schedule of Part 1(b)Detail of Contributions
2 Jan 1998 cE-6.01 Reg 2.
83ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
FORM CCC[Section 279 of the Act]
Statement Respecting Election Programs,Advertisements and Announcements
I, ______________________________________________________________ , a broadcaster, licensee of a broadcastingundertaking or publisher of a newspaper, magazine or periodical,certify that the statement set out below respectingelection programs, advertisements and announcements broadcast or published with respect to the registeredpolitical party or candidate named below in relation to the election held on __________________________________is true and accurate.
Registered Political Party (or) Candidate Amount Charged Nature of Program,(or) Person (or) Association Making Payment for Broadcast Advertisement, orfor Program, Advertisement or Announcement or Publication Announcement
Name Address
Dated at _____________ , Saskatchewan , this ________ day of _______________ , __________ .
____________________________________________________Signature of Officer in Charge (or) Publisher
_____________________________________________________Name of Broadcast Undertaking, Licenseeof Broadcast Undertaking (or) Publication
____________________________________________________Business Address
2 Jan 1998 cE-6.01 Reg 2.
FORM DDD[Subsection 252(3) of the Act]
Certificate of the Returning Officer(Number of Voters on Official Voters’ List)
Constituency of ______________________________________________________________________________________
I, ____________________________________ , the undersigned Returning Officer for the above-named constituency,certify that the number of voters whose names appear on the official voters’ list for all polling divisions in thisconstituency as enumerated, revised and corrected pursuant to section 28 of The Election Act, 1996 for the electionheld in this constituency on the ____________________ day of _________________________________ , _________ ,is ________________________________________ .
_____________________________________________________Signature of Returning Officer
2 Jan 1998 cE-6.01 Reg 2.
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
84
E-6.01 REG 2
FORM EEE[Section 5 of the Act]
Poll Book
31 Oct 2014 SR 85/2014 s5.
85ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
2 Jan 98 cE-6.01 Reg 2.
Form FFF[Section 250 of the Act]
Oath or Declaration of a Chief Official Agentof a Registered Political Party
I, _______________________________________________ of _________________________________________________ ,Chief Official Agent of ______________________________________________________ , a registered political party,
solemnly declare that I have examined the Fiscal Period Return, along with any attached certified statements tobe transmitted to the Chief Electoral Officer and now shown to me by the officer before whom this declaration ismade, and that, to the best of my knowledge and belief, that Return and any attached certified statements arecorrect;
and I further solemnly declare that, except as specified in the Return, no money, security, or equivalent for moneyhas been paid, advanced, given or deposited by anyone to me or, to the best of my knowledge and belief, to anyother person for the purpose of defraying any expenses incurred on behalf of the registered political party or forpromoting its aims;
and I further solemnly declare that, except as appears from that Return, I have not, and, to the best of myknowledge and belief, no person, club, society, company or association has, on behalf of the registered politicalparty, made any payment or incurred any liability on account of or with respect to the conduct or management ofthe affairs of the registered political party;
and I make this solemn declaration conscientiously believing it to be true, and knowing that it is of the same forceand effect as if made under oath, and by virtue of the Canada Evidence Act.
______________________________________________________Signature of Chief Official Agent
Signed and declared before me by the above-named Chief Official Agent at ___________________________ in theProvince of Saskatchewan, on the ____________ day of ________________________ , __________ .
______________________________________________________Person Authorized to Administer Oaths in Saskatchewan
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
86
E-6.01 REG 2
FORM GGG [Section 5 of the Act]
Consecutive Number
1
Name of Voter
2
Address of Voter (Street and Number or Land Location)
3
Occupation
4
Polling Division Number
5
Number on Voters’ List
6
Date Absentee Voter Application Received
7
Date Absentee Ballot Kit was forwarded
8
Address where Absentee Ballot Kit was forwarded (If different from Column 3)
9
Outer Envelope Received Outside of Deadline
10
Certificate Envelope Rejected by Returning Officer
11
Certificate Envelope Deposited in Sealed Ballot Box
enter a checkmark w
here applicable
12
Remarks
13
17 Feb 2006 SR 6/2006 s4.
87ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
FORM HHH [Section 224 of the Act]
Application to Chief Electoral Officer for Registration of a Political Party
I hereby apply to have registered, pursuant to section 224, of The Election Act, 1996, the political party named herein:
A. the full name of the political party is ;
B. the name of the political party and any abbreviation of that name that is to be shown in any election documents is ;
C. the name and address of the leader of the political party is
Name ;
Address Postal Code
D. the address of the office of the political party where records are maintained and where notices, documents and other communications pursuant to the Act may be delivered is
; Address Postal Code
E. the names and addresses of the officers of the political party are affixed, or
(i) sserddA emaN
edoC latsoP dleH eciffO
(ii) sserddA emaN
edoC latsoP dleH eciffO
(iii) sserddA emaN
; edoC latsoP dleH eciffO
F. the name and address of the chief official agent of the party is
Name ;
Address Postal Code
G. the name and address of the auditor of the party is
Name .
Address Postal Code
Attached hereto is an audited financial statement of the political party, including a statement of assets and liabilities, as ata date not more than 60 days prior to the date of this application, namely:
, 20 . tiduA fo etaD
The primary purpose of the political party is to field candidates for election as Members of the Legislative Assembly of Saskatchewan.
redaeL ytraP fo erutangiS
Dated at , Saskatchewan, this day of , 20 .
17 Feb 2006 SR 6/2006 s4.
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
88
E-6.01 REG 2
31 Oct 2014 SR 85/2015 s5.
FORM III[Subsection 89.2(1) of the Act]
Homebound Voter Application and Declaration
To: The Returning Officer, Constituency of
Part 1 Application (eligible voter who is disabled or caregiver of an eligible voter who is disabled)
I hereby apply to vote at the election now pending as provided in sections 89.1, 89.2, and 89.3, inclusive, of The Election Act, 1996.
)”htimS“ ,.g.e( emaN tsaL)”A“ ro ”ecilA“ ,.g.e( laitinI ro emaN elddiM)”yraM“ ,.g.e( emaN tsriF
G Male G Female Date of Birth (yyyy/mm/dd) (e.g., 1960/12/23) Occupation (e.g., labourer)
I am (check one):
G An eligible voter who is disabled
G Caregiver of an eligible voter who is disabled
Ordinary Residential Address (on the day the writ was issued)
Number & Street (e.g., 123 Main Street) Apartment/Unit (e.g., Apt. 4 or Unit 4) or Land Location (e.g., NE20-16-10 W3M)
, Saskatchewan City, Town or Village (e.g., Ile-a-la-Crosse) Postal Code (e.g., S4N 6B2)
Telephone: ( ) / Cell: ( )
Facsimile: ( ) / Email Address:
Part 2 Declaration of Voter ! I am the full age of 18 years or will attain the full age of 18 years on or before Polling Day;! I am a Canadian citizen or a British subject and was qualified as a voter on June 23, 1971;! I have ordinarily resided in Saskatchewan for at least six months immediately preceding the day the writ
was issued;! I was ordinarily resident in the above-mentioned constituency on the day the writ was issued; ! I am not disqualified pursuant to section 17 of The Election Act, 1996 to vote at this election; ! I am unable to vote at an Advance Poll or on Polling Day in the constituency in which I am an ordinary
resident due to a disability or I am providing care to a person with a disability and unable to vote at anAdvance Poll or on Polling Day in the constituency in which I ordinarily reside; and
! I have not already voted at this election.
I make this solemn declaration conscientiously, believing it to be true and knowing that it is of the same forceand effect as if made under oath and by virtue of the Canada Evidence Act.
Signature of Applicant Date
89ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
FORM JJJ[Clause 89.3(4)(c) of the Act]
Certificate Envelope
To be completed by the Returning Officer:
Constituency of
ofName of Voter
Address (Street and Number) and (apt. or unit) or Land Location
, Saskatchewan City, Town or Village Postal Code
To be completed by the homebound voter:
Insert ballot envelope (E-163) in this envelope, seal and complete the followingcertificate.
I certify that I am entitled to vote pursuant to section 89.1 of The Election Act,1996, because I am unable to vote at an Advance Poll or on Polling Day in theconstituency in which I am an ordinary resident due to a disability or I am providingcare to a person with a disability, and that enclosed in this envelope is a ballotenvelope that contains the ballot received by me and marked by me.
Dated this day of , 20 .
Signature of Voter
31 Oct 2014 SR 85/2014 s5.
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
90
E-6.01 REG 2
31 Oct 2014 SR 85/2014 s5.
FORM KKK[Section 89.3 of the Act]
Statement of Homebound Voters’ Ballots Delivered to the Returning Officer
Constituency of
BALLOTS COUNTED FOR EACH CANDIDATE
Number of ballots cast for:
Number of ballots cast for:
Number of ballots cast for:
Number of ballots cast for:
Number of ballots cast for:
Number of ballots cast for:
Number of rejected ballots
Axob tollab ni stollab ’sretov dnuobemoh latoT ´
´
NOTE:These Numbersmust be the same
NUMBER OF BALLOTS
Number of certificate envelopes deposited in ballot box
Number of unopened certificate envelopes rejected
Number of unopened outer envelopes received after the deadline
Number of ballot papers not returned (if any)
Number of ballot papers spoiled or declined
Number of unused ballot papers
Bstollab ’sretov dnuobemoh latoT ´
´
NOTE:TheseNumbersmust be the same
NUMBER OF BALLOTS
Total number of ballot papers assigned to the homebound voting process C
The seal locking this ballot box bears number . I certify that the above statement is correct. Dated at , Saskatchewan, this day of , 20 .
Signature of Returning Officer
91ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
FORM LLL[Sections 5, 66, and 89.3 of the Act]
Poll Book (Homebound Voters)
7654321
ConsecutiveNumber
Name of Voter Address of Voter (Street Number &
Name or Land Location)
Occupation PollingDivisionNumber
Number onVoters’
List
DateHomebound
VoterApplication
Received
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
92
E-6.01 REG 2
21110198
Date and time whenHomebound Voting
will take place
Address where Homebound Voting will occur (if difference from Column 3).
CertificateEnvelope
Rejected byReturning
Officer
CertificateEnvelope
Deposited inSealed Ballot
Box
Comments
31 Oct 2014 SR 85/2014 s5.
93ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
FORM MMM[Subsection 29.1(2) of the Act]
Application for Revision
By completing this form you are agreeing to revise information on the Voters’ List or in the Register of Votersand you are confirming that you meet the requirements as an eligible voter.
CONSTITUENCY POLLING DIVISION
Provide name of voter as it appears on Voters’ List/Register of VotersETAD HTRIB)S(EMAN ELDDIMEMAN TSRIFEMAN TSAL
(YYYY/MM/DD)
/ /
Reason for Revision
PLEASE PRINT IN BLOCK LETTERS Complete only information that needs to be revised*Denotes mandatory information
VOTER INFORMATION
*)S(EMAN ELDDIM*EMAN TSRIF*EMAN TSAL
BIRTH DATE* (YYYY/MM/DD)
/ /
REBMUN ENOHP LLECREBMUN ENOHP EMOHREDNEG
*NEZITIC NAIDANAC A MA INOITAPUCCOSSERDDA LIAME
YES G
If not a Canadian Citizen:I AM A BRITISH SUBJECT WHO QUALIFIED AS A VOTER ON JUNE 23, 1971*
YES GORDINARY RESIDENCE – COMPLETE 1, 2 OR 3
1. HOME RESIDENCE (URBAN)*
APT/UNIT NUMBER BUILDING NUMBER STREET NAM EDOC LATSOPNWOT/YTICNOITCERID/E
2. HOME ADDRESS (RURAL) PROVIDE LEGAL LAND DESCRIPTION*
REMWEGRPWTCESRTQ
NALPKCOLBTOL
3. RESERVE NAME* HOUSE NUMBER
G I have ordinarily resided in Saskatchewan for at least sixmonths immediately preceding the day the writ wasissued*
G I was ordinarily resident in this constituency on the day the writ wasissued*
MAILING ADDRESS (IF MAIL IS NOT DELIVERED TO YOUR HOME ADDRESS)
EDOC LATSOPNWOT/YTIC
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
94
E-6.01 REG 2
For use by Election Officials
DATE OF REVISION REGISTRY IDENTIFICATION NUMBER VOTER PROVIDED ACCEPTABLEINDENTIFICATION*
G YES
IF DELETION BECAUSE OF DEATH, COPY OFDEATH CERTIFICATE PROVIDED
DATE OF DEATH (YYYY/MM/DD)
/ /
Signature Date
Signature of Returning Officer/Revising Officer Date
31 Oct 2014 SR 85/2014 s5.
95ELECTION FORMS
(CHIEF ELECTORAL OFFICER) E-6.01 REG 2
FORM NNN[Section 18.6 of the Act]
Application to Access Information in Register of Voters
I request access to information in the Register of Voters for Poll No. in the constituency of for:
Name of Voter: Please print Given Name, Initial and Last Name
Address:Physical land description or street, city, postal code
Birth Date: (YYYY/MM/DD)
G For myself.
G Acting on behalf of the voter named. If acting on behalf of a voter, the reason for acting on behalf ofvoter is
The purpose of this request is to:
G Determine whether the information on the Voters’ List in the Register of Voters is correct.
G Remove information from the Register of Voters
G Not include information in the Register of Voters
In accordance with the provisions of Section 18.6 of The Election Act, 1996, I acknowledge, undertake andagree as follows with respect to the information I obtain, directly or indirectly, from the Register of Voters forSaskatchewan including any voters’ list (hereinafter “voter information”), whether the voter information is inprinted or electronic format or examined in either format without obtaining a copy.The Election Act, 1996 – Section 216(1) Any person who contravenes any provision of this Act is guilty of an offence and is liable on summaryconviction to the penalties set out in this Act with respect to that offence.(2) If no penalty is prescribed with respect to that offence, the person, if convicted, is liable to a fine of notmore than $5,000 or to imprisonment for a term not exceeding two years or to both.
I have read, understand and agree to abide by the above provisions of The Election Act, 1996.
Name (Please Print) Address
Phone number:
Signature of Applicant Address
Signature of Returning Officer or Election Official Address
31 Oct 2014 SR 85/2014 s5.
ELECTION FORMS(CHIEF ELECTORAL OFFICER)
96
E-6.01 REG 2
FORM OOO[Clauses 22(2)(b) and 22(5)(a) of the Act]
Enumeration/Registration at a PollPersonal information collected on this form will be used to register voters or to update voter information as
authorized under The Election Act, 1996. Any unauthorized use of this information is a violation of Section 216 of TheElection Act, 1996.
By providing information on this form, you are confirming that you meet the requirements as an eligible voter:
CONSTITUENCY POLLING DIVISION
PLEASE PRINT IN BLOCK LETTERS*Denotes mandatory information
VOTER INFORMATION
*)S(EMAN ELDDIM*EMAN TSRIF*EMAN TSAL
BIRTH DATE* (YYYY/MM/DD)
/ /
REBMUN ENOHP LLECREBMUN ENOHP EMOHREDNEG
*NEZITIC NAIDANAC A MA INOITAPUCCOSSERDDA LIAME
YES G
If not a Canadian Citizen:I AM A BRITISH SUBJECT WHO QUALIFIED AS A VOTER ON JUNE 23, 1971*
YES G
ORDINARY RESIDENCE – COMPLETE 1, 2 OR 3
1. HOME RESIDENCE (URBAN)*
APT/UNIT NUMBER HOUSE/BUILDING NUMBER STREET EDOC LATSOPNWOT/YTICNOITCERID/EMAN
2. HOME ADDRESS (RURAL) PROVIDE LEGAL LAND DESCRIPTION*
REMWEGRPWTCESRTQ
NALPKCOLBTOL
3. RESERVE NAME* HOUSE NUMBER
G I have ordinarily resided in Saskatchewan for at least sixmonths immediately preceding the day the writ wasissued*
G I was ordinarily resident in this constituency on the day the writ wasissued*
MAILING ADDRESS (IF MAIL IS NOT DELIVERED TO YOUR HOME ADDRESS)
EDOC LATSOPNWOT/YTIC
For use by Election Officials
REBMUN NOITACIFITNEDI YRTSIGERNOISIVER FO ETADNOITARTSIGER FO ETAD
Signature of Election Official
31 Oct 2014 SR 85/2014 s5.
REGINA, SASKATCHEWAN
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