VOTERS CERTIFICATIONS RECEIVED WITHOUT ORs

NO. LAST NAME FIRST NAME MIDDLE NAME DATE SIGNATURE

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27
28

29

30

31

32

33

34

35
 1000 7 7000
500 2 1000
200 2 400
100 8 800
50 2 100
20 6 120
10 5 50
5 11 55
1 0
9525

RECEIPT OF
COLLECTIONS 8400 875
 1000 7 7000
500 1 500
200 1 200
100 13 1300
50 2 100
20 4 80
10 5 50
5 9 45
1 0
9275

RECEIPT OF
COLLECTIONS 8400 875
 FOR REFUND
NO. LAST NAME FIRST NAME MIDDLE NAME DATE SIGNATURE

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27
28

29

30

31

32

33

34

35