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8200.9939 FORM OF OATH, SPECIFIED BY PART 8200.5100.

Use this form only if you are registering to vote with a voucher as your proof of residence.

I,_(Name of Voucher) swear or affirm that (Check one):
( ) I am pre-registered to vote in this precinct
Voter ID # _
(to be completed by the election judge)
( ) I registered in this precinct today and did not have another person vouch for me
( ) I am an employee of a residential facility
_
(Name of residential facility)
Residential Address of Voucher or Address of Residential Facility
_
Street Address City
Telephone number _
E-mail address (optional) _
I personally know that _
(Name of person registering)
is a resident of this precinct.
_
Signature of Voucher
Election Judge Official Use Only:
Subscribed and sworn to before me
__/__/____ _
Date Signature of Election Judge

The above oath shall be attached to the voter registration card and retained for at least 22 months.

Statutory Authority:

MS s 201.022; 201.061; 201.221; 203B.09

History:

20 SR 2787; 32 SR 2055; 40 SR 1553; 43 SR 437

NOTE:

The following portion of this part was vetoed by the governor at 32 SR 2060:

"( ) I am an employee of a residential facility
_
(Name of residential facility)
Residential Address of Voucher or Address of Residential Facility
_
Street Address City
Telephone number _
E-mail address (optional) _ "

Published Electronically:

October 15, 2018