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 _ | |
| Email 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.
20 SR 2787; 32 SR 2055; 40 SR 1553; 43 SR 437
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 _ | |
| Email address (optional) _ " | |
January 30, 2024
Official Publication of the State of Minnesota
Revisor of Statutes