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ADDITIONAL IMPORTANT INFORMATION FROM
ELECTORAL OFFICER, LAWRENCE LEWIS
ELECTORS ARE REMINDED OF THE FOLLOWING
IMPORTANT ELECTION CODE REQUIREMENTS
 IN ORDER TO RECEIVE A MAIL-IN BALLOT PACKAGE YOU
MUST MAKE THE REQUEST USING THE PRESCRIBED FORM
PROVIDED BY THE ELECTORAL OFFICER (ALSO ATTACHED TO THIS
DOCUMENT AND AVAILABLE ON THE ELECTION WEBSITE).
ST
ELECTION DAY – JUNE 1 , 2015
 YOU MAY MAKE YOUR NOMINATION/SECOND USING THE
PRESCRIBED FORMS (CANDIDATE DECLARATION &
NOMINATION DECLARATION) AND SUBMIT THEM TO THE
ELECTORAL OFFICER PRIOR TO THE START OF THE
NOMINATION MEETING (ALSO ATTACHED TO THIS DOCUMENT AND
AVAILABLE ON THE ELECTION WEBSITE).
NOMINATION DAY – APRIL 17TH, 2015
 PLEASE DO NOT HESITATE TO CONTACT THE ELECTORAL
OFFICER AT ANY TIME – HE WILL BE PLEASED TO ANSWER
YOUR QUESTIONS AND ASSIST YOU WITH ANY PROCESS
OR ELECTION REQUIREMENTS.
FOR MORE INFORMATION PLEASE CONTACT LAWRENCE LEWIS, ELECTORAL OFFICER
Ph/Txt: 250 889-1582 Fax: 250 384-5416 Email: lewis.l@telus.net
PO Box 35008 Hillside, Victoria, BC V8T 5G2
WWW.HFN-ELECTIONS.CA
Haisla Nation Nomination/Second Declaration Form
NOMINATION/SECOND DECLARATION
I swear and affirm that I am a registered Elector of the Haisla Nation pursuant to the
Haisla Nation Custom Election Code (2013), at the address listed below and understand
the nature of the vote and that I make this declaration freely and without compulsion,
AND WITH REGARD TO THIS ELECTION I make the following Nomination(s) and/or
Second(s):
Name of Person
Nominate for Chief or Councillor
COUNCILLOR
COUNCILLOR
COUNCILLOR
COUNCILLOR
COUNCILLOR
1.
2.
3.
4.
5
Electors may use this form for either Nominating or Seconding.
THIS SECTION TO BE COMPLETED AT THE NOMINATION MEETING BY THE PERSON MAKING THE NOMINATION/SECOND DECLARATION.
Full Legal Name:
Date of Birth (dd/mm/yyyy):
Registry Number:
Phone Number:
On-Reserve:
YES
Email:
Date:
Signature
WITNESS DECLARATION
I swear and affirm that I have witnessed the signature of the Haisla Elector above.
Full Legal Name:
Phone:
Email:
X.
Date:
Witness Signature
/
NO
2015 Haisla Nation Election
Request for Mail in Ballot
I, __________________________________________________________, swear and declare that I am an
Elector of the Haisla Nation, and wish to obtain a mail-in ballot package from the
Electoral Officer as prescribed and pursuant to the HAISLA NATION CUSTOM ELECTION
CODE (2013), and that the information contained in the Section below is truthful and
accurate.
COMPLETE THESE SECTIONS IN FULL – IF THESE SECTIONS ARE INCOMPLETE YOU MAY NOT RECEIVE A MAIL-IN BALLOT PACKAGE
Full Legal Name:
Mailing Address:
City & Province:
Postal Code:
Registry Number:
Phone Number:
Date of Birth (dd/mm/yyyy):
Email:
Date:
Signature:
WITNESS DECLARATION
I swear and affirm that I have witnessed the signature above.
Full Legal Name:
Phone:
Email:
Date:
Witness Signature:
Please complete in full, sign, have witnessed and remit immediately to:
LAWRENCE LEWIS, HFN ELECTORAL OFFICER
Ph/Txt: 250 889-1582 Fax: 250 384-5416 Email: lewis.l@telus.net
PO Box 35008 Hillside, Victoria, BC V8T 5G2
WWW.HFN-ELECTIONS.CA