Minn. R. agency 133, ch. 8200, FORMS, pt. 8200.9939
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.
Minn. R. agency 133, ch. 8200, FORMS, pt. 8200.9939
Statutory Authority: MS s 201.022; 201.061; 201.221; 203B.09