RO Correspondence Address 1

RO Name

RO Correspondence Address 1

RO Correspondence Address 2

SUBURB WA POSTCODE

Polling Place Contact Name

Name of Premises

Contact Address 1

Contact Address 3

SUBURB WA POSTCODE

Dear (name of contact)

Polling Place Arrangements

Thank you for allowing us to use your premises as a polling place for the (State General / District By / Referendum) Election to be held on Saturday (date).

The premises will be required on the Friday evening prior to polling day, to allow the Polling Place Manager to prepare the allocated area as a polling place. I have instructed the Polling Place Manager to contact (nominated contact person) to make arrangements for access to the premises, including the collection of keys.

Please would you kindly complete the attached Confirmation of Booking of Polling Place form and return it to me as soon as possible in the envelope provided.

Please contact me without delay on (RO phone number) if, for any reason, the premises are no longer available or if you require further information.

Yours sincerely

(RO Name)

RETURNING OFFICER

DISTRICT OF (DISTRICT)

Date:

Enc.

/ RO9

Confirmation of Booking of Polling Place

Electoral district / Date Of Election

The following premises have been reserved for use as a polling place for the (State General / District By / Referendum) election and is to be used on the Friday evening prior to polling day to allow for set up, and then from 6.30 am on polling day for the duration of the election, including counting after 6.00 pm.

Premises to be used as a Polling Place
Premises
Address
Postcode
Keys obtainable from
Name
Address
Postcode
Phone / Mobile
Location within the premises (e.g. hall, library, classroom 2)
Does the venue have a security system? / (Y OR N)
Will all furniture not required be removed prior? / (Y OR N)
For delivery and collection of voting materials and equipment
Name of delivery contact person
Phone / Mobile
Storage location at venue prior to polling day (materials may be delivered up to 10 days prior to polling day)
When will materials be placed in election area for set up?

Fee for usage (Inc Friday evening) $ ______

(Government buildings are used free of charge – refer to Note below)

Signature of Lessor / Date

Note: Your attention is drawn to the provisions of section 109 of the Electoral Act 1907 (as amended), which states that all buildings under the control of the Government, or the property of a Municipality and all Agricultural Halls, Mechanics’ and Mines’ Institutes, and other buildings which have been or may thereafter be subsidised in their erection by the Government, may be used free of charge, for the purposes of any nomination proceedings or poll.

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