"STATE OF _________ | |||
COUNTY OF _________, ss. | |||
I, ______, do solemnly swear that: | |||
(1) | Before becoming a resident of this state, I resided at ______ (residence address) in ______ (town, township, village or city) of ______ County in the state of ______; | ||
(2) | I moved to this state after the last day to register to vote in such general presidential election and I am now residing in the county of ______, state of Missouri; | ||
(3) | I believe I am entitled pursuant to the laws of this state to vote in the presidential election to be held November ______, ______ (year); | ||
(4) | I hereby make application for a presidential and vice presidential ballot. I have not voted and shall not vote other than by this ballot at such election. | ||
Signed __________________ | |||
(Applicant) | |||
__________________ | |||
(Residence Address) | |||
Subscribed and sworn to before me this ______ day of ______, ______ | |||
Signed __________________ | |||
(Title and name of officer authorized to administer oaths)" |
§ 115.279, RSMo