(10 ILCS 5/17-21) (from Ch. 46, par. 17-21)

Sec. 17-21.

When the votes shall have been examined and counted, the judges
shall set down on a sheet or return form to be supplied to them, the name of
every person voted for, written or printed at full length, the office
for which such person received such votes, and the number he did receive
and such additional information as is necessary to complete, as nearly
as circumstances will admit, the following form, to-wit:

TALLY SHEET AND CERTIFICATE OF

RESULTS

We do hereby certify that at the .... election held in the precinct
hereinafter (general or special) specified on (insert date), a total of
.... voters requested and received ballots and we do further certify:

Number of blank ballots delivered to us ....

Number of vote by mail ballots delivered to us ....

Total number of ballots delivered to us ....

Number of blank and spoiled ballots returned.

(1) Total number of ballots cast (in box)....

.... Defective and Objected To ballots sealed in envelope

(2) .... Total number of ballots cast (in box)

Line (2) equals line (1)

We further certify that each of the candidates for representative in
the General Assembly received the number of votes ascribed to him on the
separate tally sheet.

We further certify that each candidate received the number of votes
set forth opposite his name or in the box containing his name on the
tally sheet contained in the page or pages immediately following our
signatures.

The undersigned actually served as judges and counted the ballots at
the election on the .... day of .... in the .... precinct of the (1)
*township of ...., or (2) *City of ...., or (3) *.... ward in the city
of .... and the polls were opened at 6:00 A.M. and closed at 7:00 P.M.
Certified by us.

*Fill in either (1), (2) or (3)

A B, ....(Address)

C D, ....(Address)

E F, ....(Address)

G H, ....(Address)

I J, ....(Address)

Each tally sheet shall be in substantially one of the following forms:

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