ADTI-MMS BALLOT TALLY FORM 
Letter Ballot #: yymmdd-X
Voting Level: Committee or ADTI Metal Mining Sector
Originating Committee:
Returned To 
Committee Chairperson:            Issue Date :   
                                  Closing Date: 30 Days from Issue

Address:

                                  Chairperson (Print) ________________________ 
                                             


Phone : (  )   -                  Signature _______________________________  
                                             
FAX  :  (  )   -

E-mail    :                   
               
            Members Balloted                     _______________
               
            Ballots Returned                     _______________
               
            % Ballot Return                      _______________          
               
            Ballot Closing Date                   _______________          
               
            Approve Votes                         _______________
               
            Disapprove  Votes                     _______________
               
            Abstentions                           _______________
               
            Commenting Votes                      _______________
               
     ATTACH DISAPPROVE, COMMENT VOTES AND RELATED MEETING MINUTES