Wzór karty jednostronicowej

Okręg wyborczy nr ...................................................................	
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KARTA  DO  GŁOSOWANIA
w wyborach do Sejmu Rzeczypospolitej Polskiej
na okręgowe listy kandydatów na posłów
w dniu 25 września 2005 r.

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INFORMACJA
Głosować można tylko na jedną listę, stawiając znak „X” w kratce z lewej strony obok nazwiska jednego z kandydatów z tej listy, przez co wskazuje się jego pierwszeństwo do otrzymania mandatu. Postawienie znaku „X” w kratce obok nazwisk kandydatów z różnych list lub niepostawienie znaku „X” w żadnej kratce powoduje nieważność głosu.      

                                                    (miejsce na umieszczenie pieczęci 							        (odcisk pieczęci 
                                                      obwodowej komisji wyborczej) 							okręgowej komisji wyborczej)