LAST NAME

RECORD OF CHALLENGES

RECORD OF

CANCELLATION

WARD

FOR BOARD USE ONLY

WARD TWP

VILL

PCT SCH. DIST

ADDRESS

DATE CLERK

FIRST NAME

MIDDLE NAME

ADDRESS

DATE CLERK

DIST

TWP PCT SCH VILL

GENERAL YEAR

03 04 05 06 07 08 09 10 11

12 13 14

15 16 17 18 19 20 21 22 23 24

25 26 27 28 29 30 31 32 33 34 35

PRIMARY

SPECIAL

SPECIAL