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Election Code | |
Ballot Form | |
Section 105 | Provisional ballot envelopes. |
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20A-6-105. Provisional ballot envelopes. (1) Each election officer shall ensure that provisional ballot envelopes are printed in substantially the following form: "AFFIRMATION Are you a citizen of the United States of America? Yes No Will you be 18 years old on or before election day? Yes No If you checked "no" in response to either of the two above questions, do not complete this form. Name of Voter _________________________________________________________ First Middle Last Driver License or Identification Card Number _________________________________ State of Issuance of Driver License or Identification Card Number _________________ Date of Birth ___________________________________________________________ Street Address of Principal Place of Residence ______________________________________________________________________ City County State Zip Code Telephone Number (optional) ______________________________________________ Last four digits of Social Security Number ____________________________ Last former address at which I was registered to vote (if known) ______________________________________________________________________ City County State Zip Code Voting Precinct (if known) _________________________________________________ I, (please print your full name)__________________________do solemnly swear or affirm: That I am currently registered to vote in the state of Utah and am eligible to vote in this election; that I have not voted in this election in any other precinct; that I am eligible to vote in this precinct; and that I request that I be permitted to vote in this precinct; and Subject to penalty of law for false statements, that the information contained in this form is true, and that I am a citizen of the United States and a resident of Utah, residing at the above address; and that I am at least 18 years old and have resided in Utah for the 30 days immediately before this election. Signed ______________________________________________________________________ Dated ______________________________________________________________________ In accordance with Section 20A-3-506, wilfully providing false information above is a class B misdemeanor under Utah law and is punishable by imprisonment and by fine". "CITIZENSHIP AFFIDAVIT Name: Name at birth, if different: Place of birth: Date of birth: Date and place of naturalization (if applicable): I hereby swear and affirm, under penalties for voting fraud set forth below, that I am a citizen and that to the best of my knowledge and belief the information above is true and correct. ____________________________ Signature of Applicant In accordance with Section 20A-2-401, the penalty for willfully causing, procuring, or
allowing yourself to be registered to vote if you know you are not entitled to register to vote is up
to one year in jail and a fine of up to $2,500."
Amended by Chapter 285, 2007 General Session |
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