A. At a minimum, the following information shall be printed on the outer envelope for a provisional paper ballot:

(1)     the name and signature of the voter;

(2)     the voter’s registered address, both present and former if applicable; (3)     the voter’s date of birth;

(4)     the reason for using the ballot;

(5)     the precinct and the polling place at which the voter has voted; and

(6)     sufficient space to list the disposition of the ballot after review by the county clerk. B. A provisional paper ballot shall not be rejected for lack of the information required by this section and shall be qualified as long as the voter provides a valid signature and sufficient information for the clerk to determine the voter is a qualified elector.