OFFICIAL LETTERHEAD OF THE PROVINCIAL LEGISLATURE

To:[The Chairperson of the Select Committee]

Name of Bill:__________________________________________________

Number of Bill:_________________________________________________

Date of deliberation:_____________________________________________

Vote of legislation:_______________________________________________

[Indicate whether the committee designated by the provincial legislation votes in favour, against or abstains from voting on the Bill, and amendments, if any.]

Signature:______________________

Date:______________________

[Signature of the chairperson of the committee designated by the provincial legislature]