Part FORM OF BACK OF BALLOT PAPER: REFERENDUM IN WALES

No./Rhif....................

*County/County Borough.................... *Sir/Bwrdeistref Sirol

*Delete whichever is inapplicable

*Dileer yr un anaddas

Note.– The number on the ballot paper is to correspond with that on the counterfoil and is to be printed in small characters.

Sylwer.– Rhaid i’r rhif ar y papur pleidleisio gyfatebâ’r rhif ar yr wrthddalen a chael ei argraffu mewn cymeriadau bach.