SCHEDULELAND REFORM (SCOTLAND) ACT 2003

BALLOT RETURN FORM

1

Name of crofting community body.

2

Date of ballot.

3

Question which was put to the ballot.

4

Result of vote.

5

Number of persons eligible to vote.

6

Number of those persons who are tenants of crofts within the land which the crofting community body proposes to buy.

7

Number of persons who voted (including details of the number of proxy votes cast) and the number of those persons who are such tenants.

8

Number of persons who voted in favour of the proposal to buy and the number of those persons who are such tenants.

9

Name, address and telephone number of crofting community body representative making the ballot return.