New Jersey Statutes Title 19. Elections 19 § 17-1

After the district board shall have counted the ballots cast at such election it shall make quadruplicate statements of the result thereof in substantially the following form; provided, that if no officers or public questions were voted upon at the election by the voters of the entire State or of more than one county thereof or of a congressional district, such statements need only be made in triplicate:

A statement of the result of an election held in the ․․․․․․․․․․․․ ward of the ․․․․․․․․․․․․․․․․․․ election district of the ․․․․․․․․․․․․․․․․ of ․․․․․․․․․․․․․․․․․․ in the county of ․․․․․․․․․․, on the ․․․․․․․․․․․․․․ day of November, in the year of our Lord one thousand nine hundred and ․․․․․․․․․․․․, for a member of the Senate, members of the General Assembly, a sheriff and three coroners, for said county or as the case may be.

The whole number of names on the signature copy register or register of voters is ․․․․․․․․․․․․․․․․․․.

The whole number of names on the poll book is

The whole number of ballots rejected is

Make under each head a list of the names of all the persons for whom any vote or votes were cast for the office or offices or cast upon any public question designated therein; state opposite to the same, in words written at full length, the number of votes cast for each person for such office or offices or votes cast upon any public question and fill in all other blanks in the form above given to conform to the facts of the case.