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Schedule 1

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[r. 4 and 5]

[Heading inserted: Gazette 24 Dec 2004 p. 6250.]

Form 1

Western Australia

Referendums Act 1983 (s. 5(1))

WRIT

Writ for a referendum

To the Electoral Commissioner:

Under the Referendums Act 1983 and (1)................, I direct you to proceed with a referendum as to (2) ...............................................................................................

Polling day:

I fix Saturday, ........................................................... 20.......... as the day for the taking of the votes of the electors.(3)

Day for the return of the writ:

I fix ............... day, .................................................... 20.......... as the day for the return of the writ.

Dated ..................................... 20..... .............................................................

Governor

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