20A-6-105.  Provisional ballot envelopes.

(1)  Each election officer shall ensure that provisional ballot envelopes are printed in substantially the following form:
     “AFFIRMATION
     Are you a citizen of the United States of America? Yes No
     Will you be 18 years old on or before election day? Yes No
     If you checked “no” in response to either of the two above questions, do not complete this form.
     Name of Voter _________________________________________________________
                    First                Middle               Last
     Driver License or Identification Card Number _________________________________
     State of Issuance of Driver License or Identification Card Number _________________
     Date of Birth ___________________________________________________________
     Street Address of Principal Place of Residence
     ______________________________________________________________________
          City               County               State          Zip Code
     Telephone Number (optional) ______________________________________________
     Email Address (optional)__________________________________________________
     Last four digits of Social Security Number ____________________________
     Last former address at which I was registered to vote (if known)
     ______________________________________________________________________
          City               County               State          Zip Code
     Voting Precinct (if known) _________________________________________________
     I, (please print your full name)__________________________do solemnly swear or affirm:
     That I am eligible to vote in this election; that I have not voted in this election in any other precinct; that I am eligible to vote in this precinct; and that I request that I be permitted to vote in this precinct; and
     Subject to penalty of law for false statements, that the information contained in this form is true, and that I am a citizen of the United States and a resident of Utah, residing at the above address; and that I am at least 18 years old and have resided in Utah for the 30 days immediately before this election.
     Signed ______________________________________________________________________
     Dated ______________________________________________________________________
     In accordance with Section 20A-3a-506, wilfully providing false information above is a class B misdemeanor under Utah law and is punishable by imprisonment and by fine.
     

PRIVACY INFORMATION

Attorney's Note

Under the Utah Code, punishments for crimes depend on the classification. In the case of this section:
ClassPrisonFine
class B misdemeanorup to 6 monthsup to $1,000
For details, see Utah Code § 76-3-204

Terms Used In Utah Code 20A-6-105