Name of the Constituency Returning County Returning Officer: Officer: …………………………… …................................................... ID Number: ID Number: …………………………… …………………………… Signature: Signature: …………………………….. …………………………… Date: Date: ………………………………. ………………………………… Time: Time: …………………… …………………… FORM 39 C (r.87(2)(b)) DECLARATION OF COUNTY WOMAN MEMBER TO THE NATIONAL ASSEMBLY ELECTION RESULTS AT THE COUNTY TALLYING CENTRE S/Number..................................................... County………………………………………………….Code………………………… Name of County Tallying Centre……………………………….Code……………… Constituency Constituency Polling Name of Name of Name of Name of Votes Rejected Valid Code Name Station Polling Candidate Candidate Candidate Cast Votes Votes Code Station
Name of the Constituency Returning Officer: …………………………… ID Number: …………………………… Signature: …………………………….. Date: ………………………………. Time: …………………… County Returning Officer: …................................................... ID Number: …………………………… Signature: …………………………… Date: ………………………………… Time: …………………… FORM 39 C (r.87(2)(b)) DECLARATION OF COUNTY WOMAN MEMBER TO THE NATIONAL ASSEMBLY ELECTION RESULTS AT THE COUNTY TALLYING CENTRE S/Number..................................................... County………………………………………………….Code………………………… Name of County Tallying Centre……………………………….Code……………… Constituency Code Constituency Name Polling Station Code Name of Polling Station Name of Candidate Name of Candidate Name of Candidate Votes Cast Rejected Votes Valid Votes
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