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[as the case may be], do solemnly and sincerely declare as follows:-
1. I am the person referred to in division
of the list of
parliamentary voters and burgesses made out in divisions [or in the
] (specifying the particular list) made out for the

list of parish of

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by an entry as follows:

:

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2. My correct name and place of abode, and the correct particulars respecting my qualification, are, and ought to be stated for the purposes of the register about to be made up of voters for the parliamentary borough of and the burgess roll about to be made up of burgesses for the municipal borough of be), as follows:

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(as the case may

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The person before whom the declaration is made should affix his official

description,

Appendix.

Schedule.

To Mr.

FORM (N.)

NOTICE OF WITHDRAWAL OF OBJECTION.
No. 1.-Notice to the person objected to.

I hereby give you notice that I withdraw my objection to your name being retained on the list of ground of objection numbered

† so far as regards the in my notice to you of such

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The list should be referred to in the manner prescribed for the notice of objection.

Omit the words between crosses if the objection is wholly withdrawn. The notice should be signed in the manner prescribed for the notice of objection.

of

No. 2.-Notice to the Town Clerk.

To the Town Clerk of

I hereby give you notice that I withdraw my objection to the name being retained on the list of

the ground of objection numbered

+ so far as regards in my notice to him of

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The list should be referred to in the manner prescribed for the notice of objection.

Omit the words between crosses if the objection is wholly withdrawn. The notice should be signed in the manner prescribed for the notice of objection.

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I hereby give you notice that I revive the objection which was

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The list should be referred to in the manner prescribed for the notice of objection.

Omit the words between crosses if the objection is wholly revived.

The notice should be signed in the manner prescribed for the notice of objection.

No. 2.-Notice to the Town Clerk.

To the Town Clerk of

I hereby give you notice that I revive the objection which was

made by

since deceased, to the name of

retained on the list of objection numbered

being so far as regards the ground of in the notice to the person objected to

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Appendix.

Schedule.

(Signed)

The list should be referred to in the manner prescribed for the notice of objection.

Omit the words between crosses if the objection is wholly revived.

The notice should be signed in the manner prescribed for the notice of objection.

NOTE (P.)

Directions for the Guidance of Overseers in making out the Lists.

The following directions should be observed by overseers in making out the lists of parliamentary voters and burgesses, and also the lists of claimants and persons objected to as parliamentary voters and burgesses.

(1.) The surname and other name or names of each person are to be written at full length, the surname being placed first.

(2.) Each list, and where the list is made out in divisions, each division of each list should be made out in alphabetical order.

Note. If the local authority has given any special directions as to the mode of making out the list, the town clerk, or other officer issuing the precepts, must modify direction (2) accordingly.

(3.) The place of abode should be entered, with the name of the street, lane, or other locality, and the number in such street, lane, or other locality of such place of abode, where there is any such name or number, and should be entered in all cases in such a manner as will afford a full and sufficient address for a person entered if a letter is addressed to him by post.

(4.) The nature of the qualification should be entered as nearly as possible in the words of the statute conferring the franchise, for instance :

(a) The nature of the qualification of a person under the Reform

Act, 1832 (2 & 3 Will. 4, c. 45), or under the Municipal
Corporation Acts, should be stated thus: "house," or in the
case of a joint occupation, "house (joint)," or "warehouse,"
"counting-house,"
," "shop," or "building," or in the manner
provided by the Parliamentary and Municipal Registration
Act, 1878, as the case may be :

Appendix.
Schedule.

(b) The nature of the qualification of a person under section 3 of the Representation of the People Act, 1867, should be stated thus, "dwelling-house."

(5.) The name and situation of the qualifying property, if the qualification is in respect of property, should be entered with the name of the street, lane, or other locality, and the number in such street, lane, or other locality of such property, where there is any such name or number, and should be entered in all cases in such a manner as will afford full and sufficient means of identifying such property.

(6.) Where several qualifications are possessed by the same person, the particulars respecting each qualification should be stated in the list; and in the case of a list made out in divisions, where a person is entered in Division 1 in respect of one qualification for parliamentary purposes, and in respect of another qualification for municipal purposes, each such qualification should be distinguished in the list by a note to the effect that the qualification is for parliamentary purposes only, or for municipal purposes only, as the case may be.

(7.) In making out the list of lodger claimants who claim on or before the twenty-fifth day of July, and are then on the register in respect of the same lodgings, if you have reason to believe that any person whose name is entered on that list is dead, or is not entitled to vote, you should make a note to that effect in the last column of the list, being the column headed " objections by overseers."

(8.) You should omit from any list of parliamentary voters or burgesses the name of any person who appears from the returns furnished by the registrar of births and deaths to be dead, and the name of any person who is ascertained to be disqualified for being inserted in the list by reason of having received parochial relief or other alms.

NOTE (Q.)

Directions for Guidance in the formation of the Parliamentary
Register and Burgess Roll.

In copying and printing Divisions 1 and 2 for the parliamentary register, and Divisions 1 and 3 for the burgess roll, of any revised list made out in divisions under this Act, the two divisions in each set may, and, if and so far as the local authority under the Act shall so direct, shall be combined or kept separate, and be arranged according to convenience for use in parts for polling districts or wards, and where the polling districts and wards are not conterminous in such manner that the parts may be conveniently compiled or put together to serve either as lists for polling districts or as ward lists; and the names may, and, if and so far as the said local authority

shall so direct, shall be distinguished by a number, either alone, or in Appendix. combination with a letter or other distinguishing mark according to Schedule. the parts, and any arrangement may, and, if and so far as the said local authority shall so direct, shall be adopted according to convenience, so that one print or edition of Division 1 may be available for both sets.

Each entry for voting on the parliamentary register of every parliamentary borough, and on the burgess roll of every municipal borough whose burgess lists are revised under this Act, is to be distinguished by a number, either alone or in combination with a letter or distinguishing mark.

Any entry of a person not entitled to vote in respect of the qualification therein contained, he being on the list for voting in respect of another qualification, is to be denoted by an asterisk in the manner provided by section forty-seven of the Parliamentary Registration Act, 1843, with respect to similar entries in the registers for counties. The officer having the custody of any revised lists under this Act shall permit access thereto for the purpose of the same being copied for the parliamentary register of the parliamentary borough, and for the burgess roll of any municipal borough to which such revised lists relate.

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