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Acts Affecting Native Lands, Etc. (In English and Maori), Passed by the General Assembly, Session 1892, 1893, 1897, 1898, 1899.

Nineteenth Schedule. — Form C

page 6

Nineteenth Schedule.
Form C.

Pukapuka Pooti.

Ko te tangata Maori kei raro nei tona ingoa e marama ana ia kia pooti a te whakatunga o te tangata mo te Takiwa Pooti Maori Whaka-te hei reo mo ratou Whaka-Maori ki roto ki te Runanga Nui o Niu Tireni:—

Voting-paper.

The under-mentioned person is entitled to vote at the election of a member of the House of Representatives for the Maori Electoral District:—
Ko to Ingoa Iriiri, Maori hold, o te Tangata Pooti.
Christian Name and Surname of Elector.
Iwi.
Tribe.
Hapu.
Hapu.
Kainga.
Abode.

Tangata e pootitia ana:

Kai-titiro:

Candidate voted for:

Witness:

R.O., Returning Officer.