an affidavit of unsigned ballot that is signed by the voter, and the county election board or board of elections and registration receives the affidavit not later than noon eight (8) days after election day.
AFFIDAVIT OF UNSIGNED BALLOT |
I, [voter's name], am a registered voter of [voter's county of residence] County, State of Indiana. I declare under the penalties of perjury that I requested and returned an absentee ballot. I am a resident of the precinct in which I have voted (or I am entitled to vote in this precinct under Indiana law), and I am the person whose name appears on the absentee ballot envelope. I understand that if I commit or attempt any fraud in connection with voting, or if I aid or abet fraud or attempt to aid or abet fraud in connection with voting, I may be convicted of a felony punishable by imprisonment, a fine, or both. I understand that my failure to sign this statement means that my absentee ballot will not be counted.
___________________ |
Voter's Signature |
____________________ |
Voter's Printed Name |
________________________ |
Voter's Registration Address |
The computerized list shall preprint the name of the voter in the appropriate parts of the affidavit.
NOTICE FROM COUNTY ELECTION BOARD
REGARDING AN AFFIDAVIT OF UNSIGNED BALLOT FOR ABSENTEE BALLOT
Read these instructions carefully before completing the statement. Failure to follow these instructions may cause your ballot to not be counted.
IC 3-11.5-4-13.6