Are you the person assessed as A.B., on the [ ] rate [specifying the rate which confers the right to vote], in respect of property described to be situated in [here specify the street, &c. as described in the rate]

• Or, if the voter claim to vote as the owner of property,

• Are you the person described as the owner of the property mentioned in [ ] rate [specifying the rate], and described as being situated in [here specify the street, &c. as described in the rate]