Minn. R. agency 133, ch. 8200, FORMS, pt. 8200.9960
Current through Register Vol. 49, No. 24, December 9, 2024
| 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: | ||
Minn. R. agency 133, ch. 8200, FORMS, pt. 8200.9960
Statutory Authority: MS s 201.061; 201.221; 203B.09