Minnesota Administrative Rules

8200.9960 CHALLENGES TO VOTER REGISTRATION, FORM TO BE USED UNDER MINNESOTA STATUTES, SECTION 204C.12, SUBDIVISION 2.

I, _ , do hereby state under oath,
Name of person making challenge
I am:
( ) an election judge.
( ) a challenger authorized by Minnesota Statutes, section 204C.07.
( ) a Minnesota voter.
I reside at _ , _ ,
Street Address	City or Township
Telephone number: _
E-mail address (optional): _
I challenge the registration of _
	Name of challenged voter
whose registration lists his or her residence as
_	_
Street Address	City or Township
This challenge is based on my personal knowledge. The grounds for my challenge are: _
_
_
(attach additional sheets of signed statement if necessary).
I swear or affirm that the information stated here is truthful.

__/__/____	_
Date	Signature of Challenger
Signed and sworn to or affirmed before me
__/__/____	_
Date	Signature of Election Judge

For Election Judge Use Only:

Challenge was administered by Election Judge: _

Time: _

( ) Voter refused to take challenge oath.

( ) Challenge was dismissed: Voter passed challenge and voted.

( ) Challenge was sustained: Voter failed challenge and did not vote.

Additional Comments:

Statutory Authority:

MS s 201.061; 201.221; 203B.09

History:

32 SR 2055

Published Electronically:

May 22, 2008