Thank you for your interest in voting in the Thetis Island Residents and Ratepayers Association (TIRRA) Annual Financial Contribution Service Amendment Referendum, 2013.

• All applications will be reviewed for eligibility.
• Ballot packages will be mailed to those eligible once the ballots have been printed.
• Ballots must be returned to the CVRD Office at 175 Ingram Street, Duncan, BC, V9L 1N8, no later than 8:00 pm,
on Saturday, December 7, 2013.

First Name*

Last Name*

I am applying to vote by mail as a:*

Resident Elector

Non-Resident Property Elector

**Note to Non-Resident Property Owners: Have you already registered as a Non-Resident Property Elector? If not, please contact the Legislative Services Division at 250-746-2503 or 1-800-665-3955. If you have already registered, you may proceed with submitting this application form.

The address of my residence/property is:*

I request a ballot to vote by mail for the TIRRA Annual Financial Contribution Service Amendment Referendum, 2013 to be held on Saturday, December 7, 2013.

I am eligible to vote as I am:*

18 years of age or older on December 7, 2013; and a Canadian citizen; and a resident of BC for at least the past 6 months; and

a resident of the TIRRA Financial Contribution Service Area for at least the past 30 days OR a non-resident registered owner of real property; and not disqualified by law from voting in an election or otherwise disqualified by law.

The reason I wish to vote by mail is because (check at least one):*

I expect to be absent from Thetis Island on November 27th; December 3rd; AND December 7th

I have a physical disability, illness or injury that affects my ability to attend a voting place.

I request that the ballot package be mailed to the following address:*

Contact Information

Phone:*

Email:*