JUDGES' CERTIFICATE OF ELECTION RETURNS and 
STATEMENT OF BALLOTS

MAIL BALLOT ELECTION

§1-13.5-613, C.R.S.

JUDGES’ CERTIFICATE OF RETURNS:

		IT IS HEREBY CERTIFIED by the undersigned, who conducted the election held in the ________________ District, in                          County, Colorado, on the 3rd day  of May, 2022, that after qualifying by swearing and subscribing to their Oaths of Office, they opened the polls at 7:00 a.m., and that they kept the polls open continuously until the hour of 7:00 p.m. on said date, after which they counted the ballots cast for Directors of said District and for any ballot issues and ballot questions duly submitted, 

That the votes cast for Director of the District for a 3-year term were as follows (numeric & spelled out):
CANDIDATE	NUMBER
OF VOTES (#)	NUMBER OF VOTES 
(in words)	

			

			

That the votes cast for Director of the District for a 1-year term were as follows (numeric & spelled out):

CANDIDATE	NUMBER
OF VOTES (#)	NUMBER OF VOTES 
(in words)	

			

*That the votes cast for and against each ballot ballot question submitted were as follows:
____________________________DISTRICT BALLOT ISSUE/QUESTION A 
(insert ballot language text )

	NUMBER OF VOTES (#)	NUMBER OF VOTES 
(in words)	

YES

NO
			
*Delete of Not Applicable

It is hereby identified and specified that:

Number of Ballots Delivered to Electors:
		
		UOCAVA:			
		
		Mail Ballot		
			
Official:				
			
Unofficial:					

Substitute: 

		Total Number of Ballots Delivered to Electors:				

Number of Ballots Returned (VOTED)
                                     			
		UOCAVA:			

		Mail Ballot	
			
Official:				
			
Unofficial:					

Substitute: 

			Total Number of Ballots Returned (Voted):		

Number of Ballots Undelivered:				
	
Number of Spoiled Ballots (Replacement Ballot issued):			
						
			Number of Successfully Challenged Ballots:						
			Number of Rejected Ballots: 

			Number of Defective Ballots (do not include partial):		

Certified this 3rd day of May, 2022.    

																			Election Judge	

Election Judge

Election Judge	

*Instructions: Attach to Canvass Board’s Official Abstract of Votes Cast.
THIS IS A SAMPLE TEMPLATE. REVIEW WITH YOUR ATTORNEY