Form 9 (10554P) "Declaration of Identity" - Ontario, Canada

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Declaration of Identity – Form 9
Ministry of Municipal Affairs
and Housing
Municipal Elections Act, 1996 (Section 52 (1)1)
Instructions
To be completed by persons whose names appear on the voters' list and who do not present the prescribed proof of identity
and residence.
This application must be completed at the voting place.
Voting Place
Municipality
Ward Name or Number (if any)
Declaration
, hereby declare that I am
I,
at
(Name of Elector)
(Address)
as shown on the voters' list, and I make this declaration conscientiously believing it to be true and knowing that it is of the same
force and effect as if made under oath.
}
Declared before Deputy Returning Officer
in the
Date (yyyy/mm/dd)
Signature of Deputy Returning Officer
Signature of Person Requesting a Ballot
Save Form
Print Form
Clear Form
10554P (2022/04)
© Queen's Printer for Ontario, 2022
Disponible en français
Declaration of Identity – Form 9
Ministry of Municipal Affairs
and Housing
Municipal Elections Act, 1996 (Section 52 (1)1)
Instructions
To be completed by persons whose names appear on the voters' list and who do not present the prescribed proof of identity
and residence.
This application must be completed at the voting place.
Voting Place
Municipality
Ward Name or Number (if any)
Declaration
, hereby declare that I am
I,
at
(Name of Elector)
(Address)
as shown on the voters' list, and I make this declaration conscientiously believing it to be true and knowing that it is of the same
force and effect as if made under oath.
}
Declared before Deputy Returning Officer
in the
Date (yyyy/mm/dd)
Signature of Deputy Returning Officer
Signature of Person Requesting a Ballot
Save Form
Print Form
Clear Form
10554P (2022/04)
© Queen's Printer for Ontario, 2022
Disponible en français